Evidence map›Paper›PMID 34887093›Full record

ArticleThe Journal of thoracic and cardiovascular surgery2023

Failure to rescue: A candidate quality metric for durable left ventricular assist device implantation.

Michael J Pienta, Thomas M Cascino, Donald S Likosky, Amir A Ghaferi, Keith D Aaronson, Francis D Pagani, Michael P Thompson, Michigan Congestive Heart Failure Investigators

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of thoracic and cardiovascular surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Michael J PientaDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Mich. Electronic address: mpienta@med.umich.edu.
Thomas M CascinoDivision of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich.
Donald S LikoskyDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
Amir A GhaferiDepartment of Surgery, University of Michigan, Ann Arbor, Mich.
Keith D AaronsonDivision of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich.
Francis D PaganiDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
Michael P ThompsonDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
Michigan Congestive Heart Failure Investigators

Funding

Targeting Immune-Responsive Gene 1 (Irg1) and Itaconate for Cardioprotection of the Donor Heart for TransplantationR01HL164416 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Paul Tang · 2022 to 2026
$3.3M
Targeting Mineralocorticoid Receptor Condensates to Optimize Donor Heart PreservationR01HL166140 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Paul Tang · 2023 to 2026
$2.7M
NHLBI NIH HHS HHSN268201100025CNHLBI NIH HHS R01 HL164416NHLBI NIH HHS R01 HL166140
6 · The paper itself

Abstract

objectiveFailure to rescue (FTR), defined as death after a complication, is recognized as a principal driver of variation in mortality among hospitals. We evaluated FTR as a quality metric in patients who received durable left ventricular assist devices (LVADs) using the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support.

methodsData on 13,617 patients who received primary durable LVADs from April 2012 to October 2017 at 131 hospitals that performed at least 20 implants were analyzed from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support. Rates of major complications and FTR were compared across risk-adjusted in-hospital mortality terciles (low, medium, high) and hospital volume. Logistic regression was used to estimate expected FTR rates on the basis of patient factors for each major complication.

resultsThe overall unadjusted in-hospital mortality rate was 6.96%. Risk-adjusted in-hospital mortality rates varied 3.1-fold across terciles (low, 3.3%; high, 10.3%; P trend <.001). Rates of major complications varied 1.1-fold (low, 34.0%; high, 38.8%; P < .0001). Among patients with a major complication, 854 died in-hospital for an FTR rate of 17.7%, with 2.8-fold variation across mortality terciles (low, 8.5%; high, 23.9%; P < .0001). FTR rates were highest for renal dysfunction requiring dialysis (45.3%) and stroke (36.5%). Higher average annual LVAD volume was associated with higher rates of major complications (<10 per year, 26.7%; 10-20 per year, 34.0%; 20-30 per year, 34.0%; >30 per year, 40.1%; P trend <.0001) whereas hospitals implanting <10 per year had the highest FTR rate (<10 per year, 23.5%; 10-20 per year, 16.5%; 20-30 per year, 17.0%; >30 per year, 17.9%; P = .03).

conclusionsFTR might serve as an important quality metric for durable LVAD implant procedures, and identifying strategies for successful rescue after complications might reduce hospital variations in mortality.

Indexed as

Heart-Assist DevicesThoracic Surgical ProceduresHospital MortalityHospitalsHumansPostoperative ComplicationsRenal DialysisRetrospective Studiescomplicationsfailure to rescueleft ventricular assist deviceLVADmortality

Identifiers

PMID34887093
PMCPMC9081291

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.