(351) Exploring Sociodemographic Differences and Outcomes in Patients With LVAD and ESRD Using NIS

Sunday, February 23, 2025

12:15pm – 1:15pm Eastern Time

Location: Connections Central - RST 01

First Author(s)

Akriti Agrawal, M.B.B.S.

Guthrie Robert Packer Hospital, Pennsylvania, USA

Co-Author(s)

AS

Ankur Singla, MD

Resident Physician
Department of Internal Medicine, Northwest Health-Porter, Valparaiso, IN, United States
HB

Hitesh Bhatia, MD

Resident Physician
Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, United States
AR

Adishwar Rao, MD

Resident Physician
Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, Texas, United States
RS

Rohit Sharma, MD

Physician
Department of Internal Medicine, Mass General Brigham-Salem Hospital, Salem, MA, United States
MK

Mahathi Kunduru, MD

Dr.
Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, United States
VS

Vagisha Sharma, MD

Resident Physician
Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, United States
AS

Anubhuti Sharma, MD

Resident Physician
Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, United States
AD

Arun Dontaraju, MD

Physician
Department of Epidemiology, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
JM

Jocelyn McCullough, MD

Fellow
Department of Cardiology, Guthrie Robert Packer Hospital, Sayre, PA, United States
SS

Saurabh Sharma, MD, FACC

Assistant Professor
n/a, United States

Introduction: Left ventricular assist device (LVAD) is life-saving for patients with heart failure (HF) who don't qualify for heart transplantation, as destination therapy or bridge to definitive therapy. As the prevalence of HF increases, the dependence on LVADs increases & it may decrease mortality by 48%. End-stage renal disease (ESRD) & chronic kidney disease (CKD) often complicate post-op recovery & worsen outcomes & mortality. We aim to assess the difference in sociodemographic & hospital parameters, & comorbidities between LVAD patients with & without ESRD & CKD, using the National Inpatient Sample (NIS).

Methods: The NIS 2016-2021 was analyzed for LVAD admissions & divided into two sub-cohorts based on coexisting ESRD or CKD, using ICD-10 CM codes. Differences in characteristics were reported using Pearson’s Chi-square test & student t-test. A multivariate logistic regression model was employed to limit confounding, & adjusted odds ratios (aOR) with p-values were reported.

Results: 23, 295 patients were chosen, amongst which 40.02% had ESRD/CKD. LVAD patients with ESRD/CKD were predominantly male (82.2% vs 69.5%, p< 0.001), aged >65 years (38.5% vs 23.9%, p< 0.001), black (31.2% vs 21.8%, p< 0.001) & Medicare users (54.4% vs 39.8%, p< 0.001). They were more likely to have hypertension (89.6% vs 59.3%, p< 0.001), hyperlipidemia (38.3% vs 35.1%, p< 0.001), chronic obstructive pulmonary disease (16.7% vs 13.1%, p=0.009), obstructive sleep apnea (21.4% vs 16.4%, p=0.001), & diabetes (44% vs 28.4%, p< 0.001). Interestingly, the mortality difference was not statistically significant between the sub-cohorts & multivariate logistic regression revealed that length of stay of >7 days decreased the mortality (aOR 0.25, p< 0.001). Mortality was more likely if the patient was female (aOR 1.43, p=0.023), aged 45-65 years (aOR 1.971, p=0.002), & had hyperlipidemia (aOR 1.6, p< 0.01), liver disease (aOR 2.6, p< 0.001), or pneumonia (aOR 2.54, p< 0.001).

Conclusions: LVAD patients with ESRD/CKD were predominantly male and black, igniting the possibility of gender-based & racial disparities. Among all LVAD patients, hyperlipidemia, liver disease, & pneumonia increased mortality, though ESRD or CKD did not. There is a need for further research in this realm to prevent complications & truly sustain improved mortality.