Trends in the Use of Cardiac Assist Devices in Heart Failure Patients with Cardiogenic Shock

Introduction Currently, the most frequently used mechanical assist device for cardiogenic shock is the intra-aortic balloon pump (IABP). IABPSHOCK II trial in 2012 failed to show any benefits, therefore, the use of an IABP was downgraded to a Class IIA recommendation in the 2013 AHA/ACC guidelines. With recent innovations, the use of percutaneous ventricular assist devices (pVADs) is becoming common. We have looked at the recent trends in the use of pVADS and IABP in patients of heart failure with cardiogenic shock. Methods Data from national inpatient from the year 2002 to 2016 was used for temporal trends. ICD 9 and ICD 10 codes were used to identify patients of heart failure with cardiogenic shock and the use of heart assist devices. Pearson Chi-square was used for categorical variables and the t-test was used for continuous variables. Results We identified 319, 696 patient encounters. Median age was 68 (interquartile range 58-78) years. Mortality was very high at 27.0% (86,360). 30.8% (98,570) patients underwent left heart catheterization. Percutaneous coronary intervention (PCI) was done in 14.4% (45,914) patients. In 4.4%(13,977) external Left ventricular assist device (LVAD), in 3.0% (9525) percutaneous Ventricular assist devices (pVADs), in 20.3% (64,807) intra-aortic balloon pump (IABP) and in 9.3 (29,861) vasopressors were used. There has been an increasing trend in the use of pVADs while a decreasing trend was noticed in the use of IABP. Vasopressin and LVADs have shown a variable trend (Figure). Conclusion Use of IABP has decreased while the use of pVADs has increased over the years in patients with cardiogenic shock.