title: Unplanned hospital readmissions after HeartMate II implantation: frequency, risk factors, and impact on resource use and survival.
abstract: OBJECTIVE
  The purpose of this study was to identify potential areas for quality improvement and cost containment. We investigated readmissions after HeartMate II left ventricular assist device (LVAD) implantation by characterizing their type, temporal frequency, causative factors, and resource use and survival after readmission.
  
  
  BACKGROUND
  The HeartMate II LVAD provides enhanced survival and quality of life to end-stage heart failure patients. Whether these improved outcomes are accompanied by a similar reduction in unplanned hospital readmissions is largely unknown.
  
  
  METHODS
  From October 2004 to January 2010, 118 patients received a HeartMate II, of whom 92 were discharged on device support. Subsequent readmissions were analyzed using prospectively maintained clinical and financial databases.
  
  
  RESULTS
  Forty-eight patients (52%) had 177 unplanned hospital readmissions, 87 non-LVAD- and 90 LVAD-associated. Reasons for non-LVAD-associated readmissions included medical management of comorbidities and progression of cardiac pathology (n = 48), neuropsychiatric/psychosocial issues (n = 22), and infections (n = 17). Those for LVAD-associated readmissions included device component infection (n = 51), management of nontherapeutic anticoagulation or device malfunction (n = 22), and bleeding (n = 15). Cumulative incidence of unplanned readmissions was higher (p < 0.0001) for destination therapy than bridge-to-transplant patients (9/patient vs. 4/patient at 24 months). Cumulative hospital days overall were 25 and 42 at 12 and 18 months, respectively, and the costs were 18% and 29% of initial implantation costs. Increased number of unplanned readmissions was predictive of mortality.
  
  
  CONCLUSIONS
  Unplanned readmissions are common during HeartMate II support and negatively affect resource use and survival. Refining patient selection, especially in destination therapy patients, reducing infectious and bleeding complications, and increasing awareness about these devices might reduce unnecessary readmissions.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: smidern@ccf.org.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.affiliation: Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Hoercher
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian
authors.initials: B
authors.lastname: Lima
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Mountis
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lucy
authors.initials: L
authors.lastname: Thuita
authors.affiliation: Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Darlene M
authors.initials: DM
authors.lastname: Schmuhl
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors
keywords: heart failure; left ventricular assist devices; mechanical circulatory support