Trends in the Use of Percutaneous Ventricular Assist Devices

IMPORTANCE: Percutaneous ventricular assist devices (PVADs) provide robust hemodynamic support compared with intra-aortic balloon pumps (IABPs), but clinical use patterns are unknown. OBJECTIVE: To examine contemporary patterns in PVAD use in the United States and compare them with use of IABPs. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of adults older than 18 years who received a PVAD or IABP while hospitalized in the United States (2007-2012). MAIN OUTCOMES AND MEASURES: Temporal trends in utilization, patient and hospital characteristics, in-hospital mortality, and cost of PVAD use compared with IABP. RESULTS: During 2007 through 2012, utilization of PVADs increased 30-fold (4. 6 per million discharges in 2007 to 138 per million discharges in 2012; P for trend <. 001) while utilization of IABPs decreased from 1738 per million discharges in 2008 to 1608 per million discharges in 2012 (P for trend =. 02). In 2007, an estimated 72 hospitals used PVADs, increasing to 477 in 2011 (P for trend <. 001). The number of hospitals with an annual volume of 10 or more PVAD procedures per year increased from 0 in 2007 to 102 in 2011 (21. 4% of PVAD-using hospitals; P for trend <. 001). Among PVAD recipients, 67. 3% had a diagnosis of cardiogenic shock or acute myocardial infarction (AMI). There was a temporal increase in the use of PVADs in older patients and patients with AMI, hypertension, diabetes mellitus, and chronic kidney disease (P for trend <. 001 for all). Overall, mortality in PVAD recipients was 28. 8%, and mean (SE) hospitalization cost was 85, 580 (4165) ; both were significantly higher in PVAD recipients with cardiogenic shock (mortality, 47. 5%; mean SE cost, 113, 695 6260; P <. 001 for both). The PVAD recipients were less likely than IABP recipients to have cardiogenic shock (34. 3% vs 41. 2%; P =. 001), AMI (48. 0% vs 68. 6%; P <. 001), and undergo coronary artery bypass graft surgery (6. 2% vs 43. 2%; P <. 001), but more likely to undergo percutaneous coronary intervention (70. 9% vs 40. 4%; P <. 001). In propensity-matched analysis, PVADs were associated with higher mortality compared with IABP (odds ratio, 1. 23 95% CI, 1. 06-1. 43; P =. 007). CONCLUSIONS AND RELEVANCE: There has been a substantial increase in the use of PVADs in recent years with an accompanying decrease in the use of IABPs. Given the high mortality, associated cost, and uncertain evidence for a clear benefit, randomized clinical trials are needed to determine whether use of PVADs leads to improved patient outcomes.