PMID- 32671805 OWN - NLM STAT- MEDLINE DCOM- 20210423 LR - 20240103 IS - 1496-8975 (Electronic) IS - 0832-610X (Linking) VI - 67 IP - 12 DP - 2020 Dec TI - Long-term mortality and costs following use of Impella(R) for mechanical circulatory support: a population-based cohort study. PG - 1728-1737 LID - 10.1007/s12630-020-01755-9 [doi] AB - PURPOSE: The Impella(R) device is a form of mechanical circulatory support (MCS) used in critically ill adults with cardiogenic shock. We sought to evaluate short- and long-term outcomes following the use of Impella, including mortality, healthcare utilization, and costs. METHODS: Population-based, retrospective cohort study of adult patients (>/= 16 yr) receiving Impella in Ontario, Canada (1 April 2012-31March 2019). We captured outcomes through linkage to health administrative databases. The primary outcome was mortality during hospitalization. Secondary outcomes included mortality at 30 days, 90 days, and one year following Impella insertion. We analyzed health system costs in Canadian dollars in the year following the date of the index admission, including the costs of inpatient admission. RESULTS: We included 162 patients. Mean (standard deviation) age was 59.2 (14.5) yr, and 73.5% of patients were male. Median [interquartile range (IQR)] time to Impella insertion from date of hospital admission was 2 [1-9] days. In-hospital mortality was 56.8%, and a significant proportion of patients were bridged to a ventricular assist device (67.9%). Mortality at one year was 61.7%. Among hospital survivors, only 38.6% were discharged home independently. Median [IQR] total cost in the year following admission among all patients was $88,397 [32,718-225,628], of which $66,529 [22,789-183,165] was attributed to inpatient care. CONCLUSIONS: In-hospital mortality among patients with cardiogenic shock receiving Impella is high, but with minimal increase at one year. While Impella patients accrued substantial costs, these largely reflected inpatient costs, and not costs incurred following hospital discharge. FAU - Fernando, Shannon M AU - Fernando SM AUID- ORCID: 0000-0003-4549-4289 AD - Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca. AD - Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca. FAU - Qureshi, Danial AU - Qureshi D AD - ICES, Toronto, ON, Canada. AD - Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. AD - Bruyere Research Institute, Ottawa, ON, Canada. FAU - Tanuseputro, Peter AU - Tanuseputro P AD - ICES, Toronto, ON, Canada. AD - Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. AD - Bruyere Research Institute, Ottawa, ON, Canada. AD - School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. AD - Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. FAU - Talarico, Robert AU - Talarico R AD - ICES, Toronto, ON, Canada. AD - Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. FAU - Hibbert, Benjamin AU - Hibbert B AD - Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. FAU - Mathew, Rebecca AU - Mathew R AD - Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. AD - Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. FAU - Rochwerg, Bram AU - Rochwerg B AD - Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada. AD - Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. FAU - Belley-Cote, Emilie P AU - Belley-Cote EP AD - Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada. AD - Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada. AD - Population Health Research Institute, Hamilton, ON, Canada. FAU - Fan, Eddy AU - Fan E AD - Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. AD - Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. FAU - Combes, Alain AU - Combes A AD - Medical Intensive Care Unit, Assistance Publique-Hopitaux de Paris (APHP), Hopital Pitie Salpetriere, Paris, France. AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, Paris, France. FAU - Brodie, Daniel AU - Brodie D AD - Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. AD - Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA. FAU - Schmidt, Matthieu AU - Schmidt M AD - Medical Intensive Care Unit, Assistance Publique-Hopitaux de Paris (APHP), Hopital Pitie Salpetriere, Paris, France. AD - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, Paris, France. FAU - Simard, Trevor AU - Simard T AD - Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. FAU - Di Santo, Pietro AU - Di Santo P AD - Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. FAU - Kyeremanteng, Kwadwo AU - Kyeremanteng K AD - Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. AD - Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. AD - Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. AD - Institut du Savoir Montfort, Ottawa, ON, Canada. LA - eng PT - Journal Article TT - Mortalite a long terme et couts lies a l'utilisation de l'Impella(R) pour une assistance circulatoire mecanique: une etude de cohorte populationnelle. DEP - 20200715 PL - United States TA - Can J Anaesth JT - Canadian journal of anaesthesia = Journal canadien d'anesthesie JID - 8701709 SB - IM MH - Adult MH - Cohort Studies MH - Humans MH - Male MH - Ontario/epidemiology MH - Retrospective Studies MH - *Shock, Cardiogenic/therapy MH - Treatment Outcome OTO - NOTNLM OT - Impella OT - cardiogenic shock OT - health services OT - mechanical circulatory support EDAT- 2020/07/17 06:00 MHDA- 2021/04/24 06:00 CRDT- 2020/07/17 06:00 PHST- 2020/04/02 00:00 [received] PHST- 2020/04/27 00:00 [accepted] PHST- 2020/04/22 00:00 [revised] PHST- 2020/07/17 06:00 [pubmed] PHST- 2021/04/24 06:00 [medline] PHST- 2020/07/17 06:00 [entrez] AID - 10.1007/s12630-020-01755-9 [pii] AID - 10.1007/s12630-020-01755-9 [doi] PST - ppublish SO - Can J Anaesth. 2020 Dec;67(12):1728-1737. doi: 10.1007/s12630-020-01755-9. Epub 2020 Jul 15.