1. Left Ventricular Assist Device Therapy and Acute Pancreatitis: Higher Incidence and Worse Clinical Outcomes
- Author
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Rohan M. Goswami, Juan E. Corral, Massimo Raimondo, Lalitha P.R. Vemireddy, Yan Bi, Paul T. Kroner, Karn Wijarnpreecha, and Bhavya Yarlagadda
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Kaplan-Meier Estimate ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Risk Factors ,Intensive care ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Heart transplantation ,Heart Failure ,Hepatology ,business.industry ,Incidence ,Middle Aged ,equipment and supplies ,medicine.disease ,United States ,Pancreatitis ,030220 oncology & carcinogenesis ,Ventricular assist device ,Heart failure ,Relative risk ,Cohort ,Acute Disease ,Acute pancreatitis ,Heart Transplantation ,030211 gastroenterology & hepatology ,Female ,Heart-Assist Devices ,business - Abstract
Objective The aim of the study was to compare incidence and outcomes of acute pancreatitis among advanced heart failure therapies. Methods Two retrospective cohorts are as follows: A, patients with heart failure presenting to our hospitals and B, the US National Inpatient Sample. Three groups were compared: left ventricular assist device (LVAD) recipients, transplant recipients, and controls who did not qualify for advanced therapies. Primary outcomes were pancreatitis incidence and mortality. Secondary outcomes included kidney failure, multiorgan failure, shock, and health care utilization. Results Cohort A included 1344 heart failure patients, and cohort B included 677,905 patients with acute pancreatitis. In cohort A, annual pancreatitis incidence was 6.7 cases per 1000 LVAD recipients, 4.1 per 1000 LVAD bridge-to-transplant, 2.3 per 1000 transplant recipients, and 3.2 per 1000 heart failure controls (P = 0.03). Combined, the incidence was 5.6 per 1000 LVAD users and 2.7 in 1000 non-LVAD users (relative risk, 2.1; P = 0.009). In cohort B, increased mortality was seen in LVAD users, but not in transplant recipients. Left ventricular assist device patients had higher odds of kidney failure, multiorgan failure, shock, and intensive care. Conclusions Patients with LVAD have double risk of pancreatitis, worse clinical outcomes, and increased healthcare utilization. Studies elucidating the mechanisms behind pancreatic injury in advanced heart failure are suggested.
- Published
- 2020