A Nationwide Study On The Predictors Of In-Hospital Mortality Among Patient With Heart Failure Receiving An Intra-Aortic Balloon Pump

Background: Intra-aortic balloon pump (IABP) is an important treatment modality for patients with cardiogenic shock. However, little information is known about the actual incidence and predictors of in-hospital mortality following IABP placement. Methods: Using the National Inpatient Sample database 2009-2011, all adult patients with admission diagnosis codes of congestive heart failure and procedure codes for IABP were identified. Patients who underwent LVAD or OHT placement off IABP were excluded from the analysis. Information about demographics, insurance, year of admission, hospital characteristics, comorbidities and acute in hospital complications were abstracted from the database. Using in-hospital death as our outcome, variables that achieved statistical significance (p <0.05) using Chi square testing were included in a multivariable analysis. Results: A total of 75,744 patients were diagnosed with congestive heart failure and had IABP placement from 2009 till 2011. The mean age was 66 years. The patient’s demographics revealed a higher incidence of IABP placement in Caucasian patients (64.3%) compared to other racial minorities. The majority of IABP placement occurred in urban hospitals (94.9%) with higher number of IABP placement in teaching (56.7%) compared to non-teaching hospitals (43.3%). The overall mortality rate following IABP placement was 20%. By multivariate analysis, the presence of acute kidney injury (AKI) requiring hemodialysis was associated with the highest risk of in-hospital death; other predictors of mortality are shown in Table 1. In a subgroup analysis, predictors of mortality did not differ for patients with or without myocardial infaction. Conclusion: In this nationwide analysis, overall in-hospital mortality was high occurring in 20% of the patients following IABP placement. The presence of older age, AKI, DIC, GIB and DIC are associated with worse outcome following IABP placement.