Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Pramod Bonde

Subject Area(s)

Medicine, Surgery

Abstract

The aim of this study is to characterize the national utilization of acute mechanical circulatory support (MCS) and determine if the introduction of percuta- neous heart assist devices has reduced the mortality and hospital costs of patients with pump failure. We used the Nationwide Inpatient Sample (NIS) to analyze all adults receiving acute MCS in the United States from 2004 to 2011. From 2007 to 2011, use of percutaneous MCS devices increased 1511% compared with 101% for non-percutaneous devices. There was a trend decrease in mortality between 2004 and 2011 (P for trend = 0.027), declining from 41.1% in aggregate 2004-2007 to 33.4% in 2008-2011. A similar trend in mortality is observed for the subset of patients with cardiogenic shock (P for trend = 0.012), decreasing from 51.6% in 2004-2007 to 43.1% in 2008-2011. Hospital costs also declined significantly during this period (P for trend = 0.011). Multivariable analysis revealed CPR (OR 3.42; 95% CI, 2.16-5.41) and balloon pumps (OR 1.94; 95% CI, 1.54-2.45) prior to acute MCS were among the greatest predictors of mortality, as was coagulopathy (OR 2.28; 95% CI, 1.82-2.86). Acute MCS use has increased rapidly with the introduction of more readily deployable devices, while in-hospital mortality and associated hospital costs have decreased.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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