Clinical Outcomes for Impella Procedure in Octogenarians, Nonagenarians, and Centenarians: A Retrospective Cohort Study

The Impella, a vital ventricular assist device, has seen extensive use in managing severe heart failure and cardiogenic shock. However, the impact of this procedure on older individuals remains poorly understood. To address this gap, we scrutinized the National Inpatient Sample Database from 2019 to 2020 to elucidate in-hospital outcomes among older patients who underwent the Impella procedure. Among the 8233 patients who underwent Impella insertion, 1389 (16.8%) were in the older population, aged 80 years or older. This subgroup exhibited a higher prevalence of comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease compared to younger patients. Alarmingly, in-hospital mortality was significantly elevated among the older population. Multivariate regression analysis underscored that older patients undergoing the Impella procedure faced substantially higher inpatient mortality rates. Additionally, advanced age correlated with increased mortality. Moreover, older patients incurred greater total hospital charges and endured longer hospital stays compared to their younger counterparts. Further analysis revealed that older Impella patients were at heightened risk of experiencing complications including ventricular arrhythmia, stroke, acute kidney failure, deep vein thrombosis, and sepsis. In conclusion, our nationally representative retrospective cohort study highlights the elevated mortality and poorer outcomes associated with the Impella procedure among older patients. These findings emphasize the need for tailored approaches and enhanced vigilance when managing older individuals undergoing this intervention to improve patient outcomes and optimize care.