Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study.
Left ventricular assist device (LVAD) therapy improves survival, hemodynamic status, and end-organ perfusion in patients with refractory advanced heart failure. Hospital readmission is an important measure of the intensity of LVAD support care. We analyzed readmissions of 148 patients (mean age, 53.6 ± 12.7 yr; 83% male) who received a HeartMate II LVAD from April 2008 through June 2012. The patients had severe heart failure; 60.1% were in Interagency Registry for Mechanically Assisted Circulatory Support class 1 or 2. All patients were observed for at least 12 months, and readmissions were classified as planned or unplanned. Descriptive and multivariate regression analyses were used to identify predictors of unplanned readmission. Twenty-seven patients (18.2%) had no readmissions or 69 planned readmissions, and 121 patients (81.8%) had 460 unplanned readmissions. The LVAD-related readmissions were for bleeding, thrombosis, and anticoagulation (n=103; 49.1%), pump-related infections (n=60; 28.6%), and neurologic events (n=28; 13.3%). The readmission rate was 2.1 per patient-year. Unplanned readmissions were for comorbidities and underlying cardiac disease (54.3%) or LVAD-related causes (45.7%). In the unplanned-readmission rate, there was no significant difference between bridge-to-transplantation and destination-therapy patients. Unplanned readmissions were associated with diabetes mellitus (odds ratio [OR]=3.3; P=0.04) and with shorter mileage from residence to hospital (OR=0.998; P=0.046). Unplanned admissions for LVAD-related sequelae and ongoing comorbidities were common. Diabetes mellitus and shorter distance from residence to hospital were significant predictors of readmission. We project that improved management of comorbidities and of anticoagulation therapy will reduce unplanned readmissions of LVAD patients in the future.
Ruben E
RE
Hernandez
Steve K
SK
Singh
Dale T
DT
Hoang
Syed W
SW
Ali
MacArthur A
MA
Elayda
Hari R
HR
Mallidi
O H
OH
Frazier
Deborah E
DE
Meyers
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013781:Texas; D013997:Time Factors; D014187:Transportation of Patients; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014850:Waiting Lists
Comorbidity; diabetes complications/epidemiology/mortality/surgery; heart failure/therapy; heart-assist devices; hospital readmission; hospitalization/statistics & numerical data; left ventricular assist device; patient readmission/statistics & numerical data; retrospective studies; surgical wound infections; thrombosis; treatment outcome