Akkawi Abdul Rahman, Yamaguchi Akira, Shimamura Junichi, Chehab Omar, Alvarez Paulino, Kuno Toshiki, Briasoulis Alexandros
Department of Internal Medicine, Kansas University School of Medicine-Wichita, Wichita, KS 67214, USA.
Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan.
J Pers Med. 2024 Feb 22;14(3):236. doi: 10.3390/jpm14030236.
The 2018 heart allocation system has significantly influenced heart transplantation and left ventricular assist device (LVAD) utilization. Our study aims to investigate age-related outcomes following LVAD implantation in the post-allocation era. Using the National Inpatient Sample, we analyzed data from 7375 patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by age categories. The age groups were 18-49, 50-59, 60-69, and over 70. These represented 26%, 26%, 31%, and 17% of patients, respectively. Patients aged 60-69 and those over 70 exhibited higher in-hospital mortality rates of 12% and 17%, respectively, compared to younger age groups (7% for 18-49 and 6% for 50-59). The age groups 60-69 and over 70 were independent predictors of mortality, with adjusted odds ratios of 1.99 ( = 0.02; 95% confidence interval [CI], 1.12-3.57) and 2.88 ( = 0.002; 95% CI, 1.45-5.71), respectively. Additionally, a higher Charlson Comorbidity Index was associated with increased in-hospital mortality risk (adjusted odds ratio 1.39; = 0.02; 95% CI, 1.05-1.84). Additionally, patients above 70 experienced a statistically shorter length of stay. Nonhome discharge was found to be significantly high across all age categories. However, the difference in hospitalization cost was not statistically significant across the age groups. Our study highlights that patients aged 60 and above face an increased risk of in-hospital mortality following LVAD implantation in the post-allocation era. This study sheds light on age-related outcomes and emphasizes the importance of considering age in LVAD patient selection and management strategies.
2018年的心脏分配系统对心脏移植和左心室辅助装置（LVAD）的使用产生了重大影响。我们的研究旨在调查分配时代后LVAD植入后的年龄相关结局。利用全国住院患者样本，我们分析了2019年至2020年间接受LVAD植入的7375例患者的数据。主要终点是LVAD植入后的住院死亡率，按年龄类别分层。年龄组为18 - 49岁、50 - 59岁、60 - 69岁和70岁以上。这些分别占患者的26%、26%、31%和17%。与较年轻年龄组（18 - 49岁为7%，50 - 59岁为6%）相比，60 - 69岁和70岁以上的患者住院死亡率分别更高，为12%和17%。60 - 69岁和70岁以上年龄组是死亡率的独立预测因素，调整后的优势比分别为1.99（P = 0.02；95%置信区间[CI]，1.12 - 3.57）和2.88（P = 0.002；95% CI，1.45 - 5.71）。此外，较高的查尔森合并症指数与住院死亡风险增加相关（调整后的优势比1.39；P = 0.02；95% CI，1.05 - 1.84）。此外，70岁以上的患者住院时间在统计学上较短。在所有年龄类别中，非家庭出院率都显著较高。然而，各年龄组之间的住院费用差异无统计学意义。我们的研究强调，在分配时代后，60岁及以上的患者在LVAD植入后住院死亡风险增加。这项研究揭示了年龄相关结局，并强调了在LVAD患者选择和管理策略中考虑年龄的重要性。
