TY - JOUR
T1 - Diffusion of Percutaneous Ventricular Assist Devices in US Markets
AU - Bjarnason, Thorarinn A.
AU - Mentias, Amgad
AU - Panaich, Sidakpal
AU - Vaughan Sarrazin, Mary
AU - Gao, Yubo
AU - Desai, Milind
AU - Pandey, Ambarish
AU - Dhruva, Sanket S.
AU - Desai, Nihar R.
AU - Girotra, Saket
N1 - Funding Information:
Dr Dhruva reports receiving research funding from the National Heart, Lung, and Blood Institute (K12HL138046), the National Evaluation System for Health Technology Coordinating Center, the Food and Drug Administration, Arnold Ventures, the Greenwall Foundation, and the National Institute for Health Care Management. Dr Desai works under contract with the Centers for Medicare and Medicaid Services. He reports research grants and consulting for Amgen, AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Cytokinetics, MyoKardia, Relypsa, Novartis, and SC Pharmaceuticals. Dr Girotra is supported by a grant from the NIH (R56HL158803). He also receives funding from the American Heart Association for editorial work. The other authors report no conflicts.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: Percutaneous ventricular assist devices (PVADs) have been replacing intra-aortic balloon pumps for hemodynamic support during percutaneous coronary intervention (PCI), even though data supporting a benefit for hard clinical end points remain limited. We evaluated diffusion of PVADs across US markets and examined the association of market utilization of PVAD with mortality and cost. Methods: Using the 2013 to 2019 Medicare data, we identified all patients aged ≥65 years who underwent PCI with either a PVAD or intra-aortic balloon pump. We used hospital referral region to define regional health care markets and categorized them in quartiles based on the proportional use of PVADs during PCI. Multilevel models were constructed to determine the association of patient, hospital, and market factors with utilization of PVADs and the association of PVAD utilization with 30-day mortality and cost. Results: A total of 79 176 patients underwent PCI with either intra-aortic balloon pump (47 514 [60.0%]) or PVAD (31 662 [40.0%]). The proportion of PCI procedures with PVAD increased over time (17% in 2013 to 57% in 2019; P for trend, <0.001), such that PVADs overtook intra-aortic balloon pump for hemodynamic support during PCI in 2018. There was a large variation in PVAD utilization across markets (range, 0%-85%), which remained unchanged after adjustment of patient characteristics (median odds ratio, 2.05 [95% CI, 1.91-2.17]). The presence of acute myocardial infarction, cardiogenic shock, and emergent status was associated with a 45% to 50% lower odds of PVAD use suggesting that PVADs were less likely to be used in the sickest patients. Greater utilization of PVAD at the market level was not associated with lower risk mortality but was associated with higher cost. Conclusions: Although utilization of PVADs for PCI continues to increase, there is large variation in PVAD utilization across markets. Greater market utilization of PVADs was not associated with lower mortality but was associated with higher cost.
AB - Background: Percutaneous ventricular assist devices (PVADs) have been replacing intra-aortic balloon pumps for hemodynamic support during percutaneous coronary intervention (PCI), even though data supporting a benefit for hard clinical end points remain limited. We evaluated diffusion of PVADs across US markets and examined the association of market utilization of PVAD with mortality and cost. Methods: Using the 2013 to 2019 Medicare data, we identified all patients aged ≥65 years who underwent PCI with either a PVAD or intra-aortic balloon pump. We used hospital referral region to define regional health care markets and categorized them in quartiles based on the proportional use of PVADs during PCI. Multilevel models were constructed to determine the association of patient, hospital, and market factors with utilization of PVADs and the association of PVAD utilization with 30-day mortality and cost. Results: A total of 79 176 patients underwent PCI with either intra-aortic balloon pump (47 514 [60.0%]) or PVAD (31 662 [40.0%]). The proportion of PCI procedures with PVAD increased over time (17% in 2013 to 57% in 2019; P for trend, <0.001), such that PVADs overtook intra-aortic balloon pump for hemodynamic support during PCI in 2018. There was a large variation in PVAD utilization across markets (range, 0%-85%), which remained unchanged after adjustment of patient characteristics (median odds ratio, 2.05 [95% CI, 1.91-2.17]). The presence of acute myocardial infarction, cardiogenic shock, and emergent status was associated with a 45% to 50% lower odds of PVAD use suggesting that PVADs were less likely to be used in the sickest patients. Greater utilization of PVAD at the market level was not associated with lower risk mortality but was associated with higher cost. Conclusions: Although utilization of PVADs for PCI continues to increase, there is large variation in PVAD utilization across markets. Greater market utilization of PVADs was not associated with lower mortality but was associated with higher cost.
KW - health services research
KW - heart-assist devices
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85136745245&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85136745245&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.121.011778
DO - 10.1161/CIRCINTERVENTIONS.121.011778
M3 - Article
C2 - 35904015
AN - SCOPUS:85136745245
SN - 1941-7640
VL - 15
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 8
M1 - e011778
ER -