Abstract 4145685: Battling Cardiogenic Shock: A Comparative Study of In-Hospital Outcomes for left ventricular assist devices (LVADs) vs. intra-aortic balloon pump (IABP)

Introduction: Cardiogenic shock (CS), with a mortality rate of 30% to 50%, is a severe condition marked by the heart's inability to supply sufficient blood to meet the body's needs, which demands timely and effective intervention. Historically, the intra-aortic balloon pump (IABP) was the primary support device, but the use of left ventricular assist devices (LVADs) has increased. This study compared outcomes between CS patients treated with newer LVADs (CSLVAD) and older IABPs (CSIABP). Methods: This retrospective cohort study used the 2020 National Inpatient Sample (NIS) database to identify cardiogenic shock (CS) hospitalizations using ICD–10 codes. Our primary outcomes were in-hospital mortality, length of stay (LOS), total hospital charges (TOTCHG), and postprocedural complications among patients treated with LVADs and IABPs. Results: Out of 195,254 patients with cardiogenic shock, 2,609 received LVADs, and 21,169 received IABPs. The average age was 64.8 years for CSIABP patients and 54.8 years for CSLVAD patients. Males predominated in both groups (70.5% CSIABP, 75% CSLVAD). More Black patients received LVADs (33%) compared to IABPs (13%). Mortality was 23% in the CSIABP group versus 8% in the CSLVAD group. After adjusting for confounders, the CSLVAD group had statistically significant 62% lower odds of mortality (P=0.00, CL=0.25–0.57). The average LOS was longer in the CSLVAD group (39.4 days) compared to the CSIABP group (13.4 days), with a statistically adjusted increase of 20.1 days in the CSLVAD group (P=0.00, CL=17.6-22.6). The average TOTCHG was higher in the CSLVAD group ($1,265,731) compared to the CSIABP group ($399,160), with a statistically significant increase of $869,550 (P=0.00, CL=732,536-1,006,564). For cardiovascular outcomes, there was a 79% and 40% decrease in the odds of hypertension and CAD in the CSLVAD group(P=<0.05). Interestingly, there were increased odds of CKD, anaemia, ventricular tachycardia, hypothyroidism, postprocedural complications, supraventricular tachycardia, and atrial fibrillation in the CSLVAD group(P=<0.05). Conclusion: Patients treated with LVADs for cardiogenic shock had significantly lower mortality but higher LOS and TOTCHG compared to those treated with IABPs. Despite reduced odds of hypertension and CAD, the LVAD group had higher incidences of various complications (CKD, anaemia, ventricular tachycardia, hypothyroidism, postprocedural complications, supraventricular tachycardia, and atrial fibrillation).