National Trends in the Utilization of Short-Term Mechanical Circulatory Support Incidence, Outcomes, and Cost Analysis
National Trends in the Utilization of Short-Term Mechanical Circulatory Support Incidence, Outcomes, and Cost Analysis
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DOI：
10.1016/j.jacc.2014.07.958
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发表时间：
2014-10-07
影响因子：
24
通讯作者：
Bonde, Pramod
中科院分区：
文献类型：
--
作者：
Stretch, Robert;Sauer, Christopher M.;Bonde, Pramod
背景：在治疗预期和确定的急性循环衰竭中，主动脉内球囊反搏的替代方法越来越多。尽管短期机械循环支持（MCS）设备的临床重要性和显着的成本，他们目前的使用状态还没有在全国范围内进行分析。结论本研究的目的是表征人口统计学，治疗实践，生存率和短期MCS的成本。我们使用来自医疗保健成本和利用项目的全国住院患者样本，分析了2004年至2011年美国接受短期MCS的所有成年患者。结果从2007年至2011年，短期MCS的经皮器械使用增加了1，511%，而非经皮器械增加了101%。在此期间，死亡率从2004年至2007年的41.1%下降到2008年至2011年的33.4%（趋势p = 0.027）。在心源性休克患者亚组中观察到相似的趋势，从51.6%降至43.1%（趋势p = 0.012）。在此期间，住院费用也有所下降（趋势p = 0.011）。多变量分析显示球囊泵（比值比[OR]：2.00; 95%置信区间[CI]：1.58 - 2.52），凝血功能障碍（OR：2.35; 95% CI：1.88 - 2.94），心肺复苏（OR：3.50; 95% CI：2.20至5.57）是死亡率最重要的预测因素之一。结论短期MCS在美国的使用迅速增加，而住院死亡率则有所下降。这些变化是在与短期监控监有关的医院费用下降的背景下发生的。(C)2014年由美国心脏病学会基金会。
BACKGROUND The number of alternatives to intra-aortic balloon counterpulsation in the treatment of anticipated and established acute circulatory failure is growing. Despite the clinical importance and significant cost of short-term mechanical circulatory support (MCS) devices, the state of their present use has not been analyzed on a national scale.OBJECTIVES The purpose of this study was to characterize the demographics, treatment practices, survival rates, and cost of short-term MCS.METHODS In this serial cross-sectional study, we analyzed all adult patients receiving short-term MCS in the United States from 2004 to 2011 by using the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project.RESULTS From 2007 to 2011, use of percutaneous devices for short-term MCS increased by 1,511% compared with a 101% increase in nonpercutaneous devices. Mortality rates declined over this period (p for trend = 0.027) from 41.1% in 2004 to 2007 to 33.4% in 2008 to 2011. A similar trend was observed for the subset of patients with cardiogenic shock, decreasing from 51.6% to 43.1% (p for trend = 0.012). Hospital costs also declined over this period (p for trend = 0.011). Multivariable analysis revealed balloon pumps (odds ratio [OR]: 2.00; 95% confidence interval [CI]: 1.58 to 2.52), coagulopathy (OR: 2.35; 95% CI: 1.88 to 2.94), and cardiopulmonary resuscitation (OR: 3.50; 95% CI: 2.20 to 5.57) before short-term MCS were among the most significant predictors of mortality.CONCLUSIONS Use of short-term MCS in the United States has increased rapidly, whereas rates of in-hospital mortality have decreased. These changes have taken place in the context of declining hospital costs associated with short-term MCS. (C) 2014 by the American College of Cardiology Foundation.