{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:54:00Z","timestamp":1787018040308,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Percutaneous ventricular assist devices (PVADs) have been replacing intra-aortic balloon pumps for hemodynamic support during percutaneous coronary intervention (PCI), even though data supporting a benefit for hard clinical end points remain limited. We evaluated diffusion of PVADs across US markets and examined the association of market utilization of PVAD with mortality and cost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using the 2013 to 2019 Medicare data, we identified all patients aged \u226565 years who underwent PCI with either a PVAD or intra-aortic balloon pump. We used hospital referral region to define regional health care markets and categorized them in quartiles based on the proportional use of PVADs during PCI. Multilevel models were constructed to determine the association of patient, hospital, and market factors with utilization of PVADs and the association of PVAD utilization with 30-day mortality and cost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 79\u2009176 patients underwent PCI with either intra-aortic balloon pump (47\u2009514 [60.0%]) or PVAD (31\u2009662 [40.0%]). The proportion of PCI procedures with PVAD increased over time (17% in 2013 to 57% in 2019;\n                      <jats:italic>P<\/jats:italic>\n                      for trend, &lt;0.001), such that PVADs overtook intra-aortic balloon pump for hemodynamic support during PCI in 2018. There was a large variation in PVAD utilization across markets (range, 0%\u201385%), which remained unchanged after adjustment of patient characteristics (median odds ratio, 2.05 [95% CI, 1.91\u20132.17]). The presence of acute myocardial infarction, cardiogenic shock, and emergent status was associated with a 45% to 50% lower odds of PVAD use suggesting that PVADs were less likely to be used in the sickest patients. Greater utilization of PVAD at the market level was not associated with lower risk mortality but was associated with higher cost.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Although utilization of PVADs for PCI continues to increase, there is large variation in PVAD utilization across markets. Greater market utilization of PVADs was not associated with lower mortality but was associated with higher cost.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.121.011778","type":"journal-article","created":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T14:00:45Z","timestamp":1660658445000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Diffusion of Percutaneous Ventricular Assist Devices in US Markets"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1674-5691","authenticated-orcid":true,"given":"Thorarinn A.","family":"Bjarnason","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine (T.A.B, S.P.), Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6555-2517","authenticated-orcid":true,"given":"Amgad","family":"Mentias","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Thoracic and Vascular Institute, Cleveland Clinic, OH (A.M., M.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1643-4236","authenticated-orcid":true,"given":"Sidakpal","family":"Panaich","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine (T.A.B, S.P.), Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8717-1061","authenticated-orcid":true,"given":"Mary","family":"Vaughan Sarrazin","sequence":"additional","affiliation":[{"name":"General Internal Medicine (M.V.S, Y.G.), Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City."},{"name":"University of Iowa Carver College of Medicine and Center for Access and Delivery Research and Evaluation, Iowa City (M.V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubo","family":"Gao","sequence":"additional","affiliation":[{"name":"General Internal Medicine (M.V.S, Y.G.), Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0010-9797","authenticated-orcid":true,"given":"Milind","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Thoracic and Vascular Institute, Cleveland Clinic, OH (A.M., M.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9651-3836","authenticated-orcid":true,"given":"Ambarish","family":"Pandey","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0674-2032","authenticated-orcid":true,"given":"Sanket S.","family":"Dhruva","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco (S.S.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2384-2545","authenticated-orcid":true,"given":"Nihar R.","family":"Desai","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation and Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (N.R.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4784-4513","authenticated-orcid":true,"given":"Saket","family":"Girotra","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., S.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2013.03.002"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.098194"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.7856"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.0254"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.044007"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000836"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199908263410901"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.793745"},{"key":"e_1_3_3_10_2","unstructured":"Wennberg JE Cooper MM. 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