Diffusion of Percutaneous Ventricular Assist Devices in US Markets
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...
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| Veröffentlicht in: | Circulation. Cardiovascular interventions 2022-08, Vol.15 (8), p.e011778-e011778 |
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| creator | Bjarnason, Thorarinn A. Mentias, Amgad Panaich, Sidakpal Vaughan Sarrazin, Mary Gao, Yubo Desai, Milind Pandey, Ambarish Dhruva, Sanket S. Desai, Nihar R. Girotra, Saket |
| description | 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.
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.
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;
for trend, |
| doi_str_mv | 10.1161/CIRCINTERVENTIONS.121.011778 |
| format | Article |
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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.
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;
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.
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.</description><identifier>ISSN: 1941-7632</identifier><identifier>ISSN: 1941-7640</identifier><identifier>EISSN: 1941-7632</identifier><identifier>DOI: 10.1161/CIRCINTERVENTIONS.121.011778</identifier><identifier>PMID: 35904015</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Heart-Assist Devices ; Humans ; Intra-Aortic Balloon Pumping - adverse effects ; Medicare ; Percutaneous Coronary Intervention - adverse effects ; Shock, Cardiogenic ; Treatment Outcome ; United States</subject><ispartof>Circulation. Cardiovascular interventions, 2022-08, Vol.15 (8), p.e011778-e011778</ispartof><rights>Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4223-e52940a4328c95b31cea8582cd24c41fd3a849b7066ac9e918a55aa7236219283</citedby><cites>FETCH-LOGICAL-c4223-e52940a4328c95b31cea8582cd24c41fd3a849b7066ac9e918a55aa7236219283</cites><orcidid>0000-0003-0674-2032 ; 0000-0003-2384-2545 ; 0000-0001-6555-2517 ; 0000-0003-1643-4236 ; 0000-0001-9651-3836 ; 0000-0003-1674-5691 ; 0000-0003-0010-9797 ; 0000-0001-8717-1061 ; 0000-0002-4784-4513</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35904015$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bjarnason, Thorarinn A.</creatorcontrib><creatorcontrib>Mentias, Amgad</creatorcontrib><creatorcontrib>Panaich, Sidakpal</creatorcontrib><creatorcontrib>Vaughan Sarrazin, Mary</creatorcontrib><creatorcontrib>Gao, Yubo</creatorcontrib><creatorcontrib>Desai, Milind</creatorcontrib><creatorcontrib>Pandey, Ambarish</creatorcontrib><creatorcontrib>Dhruva, Sanket S.</creatorcontrib><creatorcontrib>Desai, Nihar R.</creatorcontrib><creatorcontrib>Girotra, Saket</creatorcontrib><title>Diffusion of Percutaneous Ventricular Assist Devices in US Markets</title><title>Circulation. Cardiovascular interventions</title><addtitle>Circ Cardiovasc Interv</addtitle><description>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.
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.
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;
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.
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.</description><subject>Aged</subject><subject>Heart-Assist Devices</subject><subject>Humans</subject><subject>Intra-Aortic Balloon Pumping - adverse effects</subject><subject>Medicare</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Shock, Cardiogenic</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>1941-7632</issn><issn>1941-7640</issn><issn>1941-7632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkEtPwzAQhC0Eorz-AsqBA5cUr1-xJS6lFKgEBUHharnuRg1NG7ATEP-eoABC4rDaOczMrj5CjoD2ARScDMf3w_FkOrp_Gk2m49vJQx8Y9ClAlukNsgNGQJopzjb_6B7ZjfGZ0lYqtk16XBoqKMgdcnZe5HkTi2qdVHlyh8E3tVtj1cTkCdd1KHxTupAMYixinZzjW-ExJsU6eXxIblxYYh33yVbuyogH33uPPF6MpsOr9Pr2cjwcXKdeMMZTlMwI6gRn2hs54-DRaamZnzPhBeRz7rQws4wq5bxBA9pJ6VzGuGJgmOZ75LjrfQnVa4OxtqsieizL7l_LlFFacZCitZ52Vh-qGAPm9iUUKxc-LFD7RdH-o2hbiraj2MYPvy81sxXOf8M_2FqD6AzvVVljiMuyecdgF-jKetG2cJ4JI1NGGaOaUpq2Qzn_BFh-foo</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Bjarnason, Thorarinn A.</creator><creator>Mentias, Amgad</creator><creator>Panaich, Sidakpal</creator><creator>Vaughan Sarrazin, Mary</creator><creator>Gao, Yubo</creator><creator>Desai, Milind</creator><creator>Pandey, Ambarish</creator><creator>Dhruva, Sanket S.</creator><creator>Desai, Nihar R.</creator><creator>Girotra, Saket</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0674-2032</orcidid><orcidid>https://orcid.org/0000-0003-2384-2545</orcidid><orcidid>https://orcid.org/0000-0001-6555-2517</orcidid><orcidid>https://orcid.org/0000-0003-1643-4236</orcidid><orcidid>https://orcid.org/0000-0001-9651-3836</orcidid><orcidid>https://orcid.org/0000-0003-1674-5691</orcidid><orcidid>https://orcid.org/0000-0003-0010-9797</orcidid><orcidid>https://orcid.org/0000-0001-8717-1061</orcidid><orcidid>https://orcid.org/0000-0002-4784-4513</orcidid></search><sort><creationdate>20220801</creationdate><title>Diffusion of Percutaneous Ventricular Assist Devices in US Markets</title><author>Bjarnason, Thorarinn A. ; Mentias, Amgad ; Panaich, Sidakpal ; Vaughan Sarrazin, Mary ; Gao, Yubo ; Desai, Milind ; Pandey, Ambarish ; Dhruva, Sanket S. ; Desai, Nihar R. ; Girotra, Saket</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4223-e52940a4328c95b31cea8582cd24c41fd3a849b7066ac9e918a55aa7236219283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Heart-Assist Devices</topic><topic>Humans</topic><topic>Intra-Aortic Balloon Pumping - adverse effects</topic><topic>Medicare</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Shock, Cardiogenic</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bjarnason, Thorarinn A.</creatorcontrib><creatorcontrib>Mentias, Amgad</creatorcontrib><creatorcontrib>Panaich, Sidakpal</creatorcontrib><creatorcontrib>Vaughan Sarrazin, Mary</creatorcontrib><creatorcontrib>Gao, Yubo</creatorcontrib><creatorcontrib>Desai, Milind</creatorcontrib><creatorcontrib>Pandey, Ambarish</creatorcontrib><creatorcontrib>Dhruva, Sanket S.</creatorcontrib><creatorcontrib>Desai, Nihar R.</creatorcontrib><creatorcontrib>Girotra, Saket</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bjarnason, Thorarinn A.</au><au>Mentias, Amgad</au><au>Panaich, Sidakpal</au><au>Vaughan Sarrazin, Mary</au><au>Gao, Yubo</au><au>Desai, Milind</au><au>Pandey, Ambarish</au><au>Dhruva, Sanket S.</au><au>Desai, Nihar R.</au><au>Girotra, Saket</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diffusion of Percutaneous Ventricular Assist Devices in US Markets</atitle><jtitle>Circulation. Cardiovascular interventions</jtitle><addtitle>Circ Cardiovasc Interv</addtitle><date>2022-08-01</date><risdate>2022</risdate><volume>15</volume><issue>8</issue><spage>e011778</spage><epage>e011778</epage><pages>e011778-e011778</pages><issn>1941-7632</issn><issn>1941-7640</issn><eissn>1941-7632</eissn><abstract>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.
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.
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;
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.
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.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>35904015</pmid><doi>10.1161/CIRCINTERVENTIONS.121.011778</doi><orcidid>https://orcid.org/0000-0003-0674-2032</orcidid><orcidid>https://orcid.org/0000-0003-2384-2545</orcidid><orcidid>https://orcid.org/0000-0001-6555-2517</orcidid><orcidid>https://orcid.org/0000-0003-1643-4236</orcidid><orcidid>https://orcid.org/0000-0001-9651-3836</orcidid><orcidid>https://orcid.org/0000-0003-1674-5691</orcidid><orcidid>https://orcid.org/0000-0003-0010-9797</orcidid><orcidid>https://orcid.org/0000-0001-8717-1061</orcidid><orcidid>https://orcid.org/0000-0002-4784-4513</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1941-7632 |
| ispartof | Circulation. Cardiovascular interventions, 2022-08, Vol.15 (8), p.e011778-e011778 |
| issn | 1941-7632 1941-7640 1941-7632 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2696863154 |
| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Heart-Assist Devices Humans Intra-Aortic Balloon Pumping - adverse effects Medicare Percutaneous Coronary Intervention - adverse effects Shock, Cardiogenic Treatment Outcome United States |
| title | Diffusion of Percutaneous Ventricular Assist Devices in US Markets |
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