Nationwide analysis of in-hospital mortality and renal infarction trends following cardiac output assist device placement from 2017 to 2020

Abstract Background Cardiac output assist devices (COAD) have become a crucial therapeutic option for advanced heart failure patients. However, the clinical outcomes and complications associated with cardiac output device placement, especially in relation to renal health, remain a subject of concern. Purpose We aimed to examine temporal trends of in-hospital mortality and renal infarct (RI) among heart failure in patients who underwent placement of cardiac output assist devices, including intra-aortic balloon pumps and impeller-based devices, between 2017 and 2020. Methods The National Inpatient Sample was queried from 2017 to 2020 to identify all adults who underwent COAD using the International Classification of Diseases 10th Revision codes. The Cochran-Armitage test was used to assess the linear trend of in-hospital RI among patients with COAD. Multivariate and univariate regression analysis was conducted to assess the yearly association of COAD with in-hospital mortality and RI with COAD. The Elixhauser comorbidity index was used to adjust for confounders. Linear logistic results are represented as adjusted odds ratios (ORs) with their respective 95% Confidence Intervals (CI). Results Of the 176,225 patients who underwent COAD, 385 (0.2%) experienced RI, predominantly male (72%) with a mean age of 58. Trend analysis showed an upward trend in RI (trend: 0.21%, p < 0.001) associated with COAD from 2017 to 2020. In 2018, 0.19% of patients had RI (OR = 3, 95% CI 2.1-6.1, p < 0.001), 0.23% in 2019 (OR = 4.6, 95% CI 2.5-7, p < 0.001), and 0.29% in 2020 (OR = 3.6, 95% CI 2.3-5.9, p < 0.001), compared to 0.17% in 2017 (OR = 2.3, 95% CI 1.1-4.7) demonstrated in Figure 1. Mortality among RI and COAD patients was 40% in 2017 (OR 3, 95% CI 1.2-8.9, p = 0.04), decreased to 24% in 2018 (OR 1.2, p = 0.69), but increased to 43% in 2019 (OR 3.2, 95% CI 1.2-7.9, p = 0.01) and remained high at 42% in 2020 (OR 2.9, 95% CI 1.3-6.9, p = 0.019) as illustrated in Table 1. Overall, in-hospital mortality was 38% (OR 2.5, 95% CI 1.5-4, p < 0.001). Conclusions Our study identified a rising trend in in-hospital RI rates among patients with cardiac output assist devices from 2017 to 2020, accompanied by a significant risk of in-hospital mortality. Despite these complications occurring in a small percentage of individuals, they highlight the critical need for vigilant monitoring and proactive management in this patient population.Figure 1