Key result
Underlying hypertrophic cardiomyopathy was associated with significantly increased in-hospital mortality in patients receiving left ventricular assist devices (OR 3.06) and short-term mechanical circulatory support (OR 1.8).
Why the study?
Data on in-hospital outcomes of hypertrophic cardiomyopathy patients placed on mechanical circulatory support devices and receiving heart transplantation is limited.
Does underlying hypertrophic cardiomyopathy increase in-hospital mortality in patients undergoing mechanical circulatory support or heart transplantation?
Observational (n=254,170)
Yes
Does underlying hypertrophic cardiomyopathy increase in-hospital mortality in patients undergoing mechanical circulatory support or heart transplantation?
Odds Ratio: 3.06 (95% CI 1.18–7.93)
p-value: p=0.02
Underlying hypertrophic cardiomyopathy is associated with significantly higher in-hospital mortality, longer length of stay, and higher costs in patients receiving mechanical circulatory support, but not in those undergoing heart transplantation.
Objective Understand the outcomes of mechanical circulatory support devices (MCSD) and heart transplantation (HT) in patients with underlying hypertrophic cardiomyopathy (HCM). Introduction HCM can rarely cause severe left ventricular outflow tract obstruction and apical ballooning presenting as cardiogenic shock necessitating the use of mechanical circulatory support devices (MCSD). Data on in-hospital outcomes of HCM patients placed on MCSD and receiving HT is limited. Methods The National Inpatient Sample (2016-2019) was used for the retrospective analysis of patients hospitalized for MCSD and HT using ICD-10 codes. These patients were divided into two cohorts, with and without HCM, and compared in terms of in-hospital mortality, trends in mortality rates, hospitalization costs and mean length of stay. Results Among 254170 patients hospitalized for MCSD and HT, 12,000 patients had underlying HCM. Underlying HCM was associated with increased odds of mortality in patients receiving left ventricular assist devices (LVAD) (OR 3.06, 95% CI 1.18-7.93, p =0.02) and short-term MCSD (OR 1.8, CI 1.29-2.5, p<0.001. HCM was not associated with increased mortality in patients hospitalized for HT (OR 1.05, CI 0.42-2.6, p =0.9). Patients with HCM undergoing MCSD and HT had a longer mean length of stay (26.6 vs 14.4 days, p<0.0001), and higher mean hospitalization charges ($977797 vs $497590, p<0.0001) as compared to non-HCM patients. Conclusion Underlying HCM is associated with increased in-hospital mortality in patients undergoing LVAD and short-term MCSD placement. Further prospective studies are required to expand our understanding of prognosis of HCM in patients undergoing MCSD and establish management guidelines.
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Hussain et al. (2023) conducted an observational in Hypertrophic cardiomyopathy requiring mechanical circulatory support or heart transplantation (n=254,170). Underlying hypertrophic cardiomyopathy vs. Without hypertrophic cardiomyopathy was evaluated on In-hospital mortality for patients receiving left ventricular assist devices (LVAD) (OR 3.06, 95% CI 1.18-7.93, p=0.02). Underlying hypertrophic cardiomyopathy was associated with significantly increased in-hospital mortality in patients receiving left ventricular assist devices (OR 3.06) and short-term mechanical circulatory support (OR 1.8).
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