Advertisement

Trends in LVADs in the Geriatric Population: Demographics for 2003–2014

      Introduction: Left ventricular assist devices (LVAD) have become the mainstay therapy for advanced heart failure patients along with orthotropic heart transplant (OHT). While OHT is limited by donor organ availability, LVAD utilization has consistently increased in recent years. It is unclear if increased LVAD utilization has benefited elderly patient's ≥75 years old with multiple comorbidities. Method: We used the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient database in the United States, to determine the recent trends of LVAD implantation. We stratified the patients according to age groups and degree of comorbidity using Deyo-Charlson comorbidity scores. We studied the trends and the mortality associated with LVAD implantation in this comorbid advanced age group. Results: Between 2003 and 2014, a total of 21,323 LVADs were implanted nationwide with a consistent increase across the years (726 in 2003 to 3855 in 2014). Age stratified analysis revealed increased LVAD implantations in the age group ≥75 years between 2003–2014, with only 3.5% (23) of the total LVADs implanted in this age group in 2003 compared to 10.5% (405) in 2014 (P trend <0.05). Despite adjustment for heart failure (HF) admission rates, a significant gender disparity in LVAD utilization in this age group, favoring men (2.3 LVAD implantations per 1000 HF admissions for men vs 1.1 LVAD implantations per 1000 HF admissions for females, P < .05) which has stayed consistent across all the 12 year study period. After adjustment for heart failure admissions, no disparities were noted across racial groups. Although the number of LVAD implantations performed in patients with advanced age and high Charlson scores (≥4) increased significantly (33% in 2003 vs 68%, P trend <0.05), in-hospital mortality associated with LVAD implantation showed a consistent and significant decrease from 2003 to 2014 (61.3% to 17.6%, P trend < 0.05). Conclusion: Our analysis confirms that 1) Number of LVAD implants in patients with advanced age have increased significantly between 2003–2014; 2) There is significant gender disparity in LVAD utilization among this advanced age group, favoring men across all the 12 year study period; 3) More patients with advanced age and multiple co-morbidities are receiving LVAD implantation with improved survival outcomes.