Impact of pre-existing cancer on short-term outcomes and mortality following left ventricular assist device implantation at urban teaching centers in the United States.

Abstract

e23056 Background: Cancer patients are at higher odds of various procedural complications. A recent study suggested a rise in the use of left ventricular assist device (LVAD) implantation in recent years, yet the demographics and mortality remain poorly described. Methods: We conducted a retrospective study of adults undergoing LVAD implantation using the National Inpatient Sample, excluding COVID-19 admissions. Patients were stratified by pre-existing cancer. Demographics, comorbidities, and hospitalization characteristics were compared. The primary outcome was in-hospital mortality. Results: Among 25,935 left ventricular assist device recipients, 745 (2.87%) had cancer. Cancer patients were older (59.3±1.0 vs 56.9±0.2 years; p=0.017) and more often female (28.9% vs 22.6%; p=0.083). Most were White (66.9% vs 58.8%), followed by Black (23.0% vs 28.2%) and Hispanic (3.6% vs 6.9%). Elective admissions were similar (28.2% vs 26.8%). Cardiovascular and systemic comorbidities were comparable, including acute myocardial infarction (6.0% vs 4.3%), prior myocardial infarction (13.4% vs 14.7%), dyslipidemia (33.6% vs 37.0%), diabetes mellitus (36.2% vs 38.1%), hypertension (73.8% vs 77.8%), chronic kidney disease (49.7% vs 47.1%), obesity (17.5% vs 21.3%), chronic obstructive pulmonary disease (16.1% vs 15.1%), obstructive sleep apnea (15.4% vs 19.1%), peripheral vascular disease (36.2% vs 37.4%), coagulopathy (40.9% vs 45.3%), history of coronary artery bypass grafting (6.0% vs 7.3%), history of percutaneous coronary intervention (10.7% vs 9.6%), prior stroke (5.4% both), smoking (21.5% vs 26.8%), alcohol abuse (2.0% vs 3.6%), and drug abuse (5.4% vs 4.4%) (p>0.05). Primary expected payer differed (p=0.007), with cancer patients more often covered by private insurance (45.6% vs 33.1%) and less often by Medicaid (6.0% vs 14.5%) or Medicare (46.3% vs 48.3%). Unadjusted in-hospital mortality was higher in cancer patients (14.1% vs 10.6%), but doubly robust adjustment showed no significant association (adjusted odds ratio 1.54, 95% confidence interval 0.83–2.84; p=0.172). Length of hospital stay and inflation-adjusted mean hospital charges were similar. Conclusions: Cancer patients undergoing LVAD implantation were older but presented with a comorbidity profile comparable to non-cancer patients. While short-term in-hospital mortality did not show a statistically significant difference after adjustment, these findings may be influenced by survivor bias and highly selective candidacy criteria for advanced heart failure therapies. Further prospective studies are needed to evaluate long-term post-discharge outcomes and to determine if these results remain consistent across various cancer stages and types.