title: Risk Factors and Outcomes of Gastrointestinal Bleeding in Left Ventricular Assist Device Recipients.
abstract: Increasing use of left ventricular assist devices (LVADs) has been accompanied by rising incidence of gastrointestinal bleeding (GIB). Objectives of this study were to determine the yearly incidence of GIB in LVAD recipients, compare outcomes of continuous-flow (CF) and pulsatile-flow LVAD eras, and investigate for risk factors. The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database from 2005 to 2010 was analyzed. Primary outcome of interest was incidence of GIB in LVAD recipients. Multivariate logistic regression model was used to examine independent associations of GIB with risk factors and outcomes. An estimated 8,879 LVAD index admissions and 8,722 readmissions in LVAD recipients over 6 years were analyzed. The yearly incidence of GIB after LVAD implantation increased from 5% in 2005 to 10% in 2010. On multivariate regression analysis, the odds of GIB was 3.24 times greater (95% confidence interval 1.53 to 6.89) in the era of CF LVADs than in the era of pulsatile-flow LVADs. Compared to their younger counterparts, in LVAD recipients aged >65 years, the adjusted odds of GIB was 20.5 times greater (95% confidence interval 2.24 to 188). GIB did not significantly increase the inhospital mortality but increased the inpatient length of stay. In conclusion, the incidence of GIB in LVAD recipients has increased since the use of CF LVADs has increased, leading to greater inpatient lengths of stay and hospital charges. Older recipients of CF LVADs appear to be at a greater risk of GIB.
authors.affiliation: Department of Internal Medicine, University of Iowa, Iowa City, Iowa. Electronic address: joymedicine2@gmail.com.
authors.forename: Parijat Saurav
authors.initials: PS
authors.lastname: Joy
authors.affiliation: Department of Critical Care, Phoebe Putney Memorial Hospital, Albany, Georgia.
authors.forename: Gagan
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Department of Hematology and Oncology, SUNY Downstate Medical Center, New York, New York.
authors.forename: Achuta Kumar
authors.initials: AK
authors.lastname: Guddati
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa, Iowa City, Iowa.
authors.forename: Jay Kumar
authors.initials: JK
authors.lastname: Bhama
authors.affiliation: Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
authors.forename: Linda Marie
authors.initials: LM
authors.lastname: Cadaret
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000925:Anticoagulants