Utilization of Implantable Cardioverter Defibrillators Among Patients with a Left Ventricular Assist Device: Insights From a National Database

The trends of implantable cardioverter defibrillator (ICD) use in patients with a durable left ventricular assist device (LVAD) remain uncertain. We used the National Inpatient Sample to identify hospitalizations between 2009 and 2018 in which patients received a new LVAD or had a pre-existing one. Procedure codes were then used to identify hospitalizations in which a new ICD was implanted. In 34,113 hospitalizations for new and/or replacement LVADs, an ICD was implanted in 1297 (3.8%). The rate of ICD implantation along with an LVAD declined from 2009 to 2018 (annual percent change: -23.2%; P-trend < 0.001). Independent factors associated with concurrent ICD implantation in patients receiving LVAD were younger age, White (compared with Black) race, and in-hospital cardiac arrest. Concurrent ICD implantation was associated with a longer hospital stay (adjusted mean difference: 4.48 days) and higher inflation-adjusted costs (adjusted mean difference: $31,679), but lower in-hospital mortality rates (adjusted odds ratio: 0.29; P < 0.001), compared with LVAD placement alone. Amongst 95,583 hospitalizations of patients with a pre-existing LVAD, an ICD was placed in 616 (0.64%). There was no change in the rate of ICD implantation from 2009 to 2018 in patients with a pre-existing LVAD (annual percent change: -10.34%; P = 0.18).