Impacts of Hospital Volume and Patient-Hospital Distances on Outcomes of Older Adults Receiving Percutaneous Microaxial Ventricular Assist Devices for Cardiogenic Shock.

Autor:	Watanabe A; Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY (A.W.)., Miyamoto Y; Department of Real-World Evidence, The University of Tokyo, Japan (Y.M.)., Ueyama HA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.A.U.)., Gotanda H; Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.)., Jentzer JC; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (J.C.J.)., Kapur NK; The Cardiovascular Center, Tufts Medical Center, Boston, MA (N.K.K.)., Jorde UP; Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (U.P.J., T.K.)., Tsugawa Y; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at The University of California, Los Angeles (Y.T.).; Department of Health Policy and Management, The University of California, Los Angeles Fielding School of Public Health (Y.T.)., Kuno T; Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (U.P.J., T.K.).; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (T.K.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2024 Dec; Vol. 17 (12), pp. e014738. Date of Electronic Publication: 2024 Oct 29.
DOI:	10.1161/CIRCINTERVENTIONS.124.014738
Abstrakt:	Background: Percutaneous microaxial ventricular assist devices (pVADs) have the potential to reduce mortality of patients with cardiogenic shock (CS). However, the association between the distribution of pVAD-performing centers and outcomes of CS has not been explored. Methods: This observational study included Medicare fee-for-service beneficiaries aged 65 to 99 years treated with pVAD for CS from 2016 to 2020. It examined the associations between patient outcomes and 2 exposure variables: hospitals' procedure volumes of pVAD and patient-hospital distances (in quintiles [Qn]). We developed Cox proportional hazards regression for 180-day mortality and heart failure readmission rates, and multivariable logistic regression for in-hospital outcomes, adjusting for patient demographics, comorbidities, concomitant treatments, and hospital characteristics, including CS volume, teaching status, and the ability to perform extracorporeal membrane oxygenation. Results: A total of 6637 patients with CS underwent pVAD at 1041 hospitals, with the annualized hospital volume ranging widely from 0.3 to 55.6 cases/year. Patients treated at higher-volume centers experienced lower 180-day mortality compared with those treated at lower-volume centers (Qn1=reference; Qn2: adjusted hazard ratio [aHR], 0.88 [95% CI, 0.79-0.97]; Qn3: aHR, 0.88 [95% CI, 0.79-0.98]; Qn4: aHR, 0.88 [95% CI, 0.78-0.99]; Qn5: aHR, 0.84 [95% CI, 0.74-0.95]; P for trend, 0.026), while we found no evidence that patient-hospital distances were associated with mortality (Qn1=reference; Qn2: aHR, 0.99 [95% CI, 0.89-1.09]; Qn3: aHR, 0.94 [95% CI, 0.85-1.04]; Qn4: aHR, 1.01 [95% CI, 0.92-1.11]; Qn5: aHR, 0.91 [95% CI, 0.82-1.01]; P for trend, 0.160). We found no evidence that the hospital volume and patient-hospital distances were associated with in-hospital bleeding, intracranial hemorrhage, or renal replacement therapy initiation. Conclusions: Hospital volume was more strongly associated with mortality than patient-hospital distances, suggesting that rational distribution of pVAD-performing centers while ensuring adequate procedure volumes may optimize patient mortality. Competing Interests: Dr Kapur has received consulting/speaker fees from Abbott, Abiomed, Boston Scientific, Edwards, Getinge, LivaNova, Teleflex, and Zoll; and has received consulting honoria and institutional research grants from Abbott, Abiomed, Boston Scientific, Getinge, LivaNova, and Teleflex. Dr Jorde is a consultant for Abbott, Edwards Lifesciences, and Ancora Heart (no honoraria). Dr Tsugawa reported serving on the board of directors for M3, Inc.The other authors report no conflicts.
Databáze:	MEDLINE
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