title: Post-acute Care Trajectories in the First Year Following Hospital Discharge After Left Ventricular Assist Device Implantation.
abstract: Patients with advanced heart failure who undergo left ventricular assist device (LVAD) implantation are heavy users of post-acute care services. We sought to better describe the post-acute trajectories and burden of care transitions for this patient population.
  
  
  
  We conducted a retrospective cohort study of 227 patients who were discharged after index hospitalization for LVAD implantation. Of these, 162 (71%) were discharged home, and 65 (29%) were discharged to a facility, including long-term acute care hospitals (n = 50), inpatient rehabilitation facilities (n = 11), and skilled nursing facilities (n = 4). Follow-up extended to 1 year, with censoring at date of heart transplantation, LVAD removal, death, or loss of follow- up. In the first year post-discharge, those patients initially discharged home spent a mean 265 days at home, 0.5 days in a facility, and 13 days in the hospital as result of readmission. Those initially discharged to a facility spent a mean 241 days at home, 37 days in a facility, and 19 days in the hospital as result of readmission. Patients initially discharged home experienced fewer care transitions, 4.2 vs 5.2 transitions per patient, compared with those initially discharged to a facility.
  
  
  
  In the first year following index hospitalization for LVAD implantation, patients initially discharged to a facility have an increased burden of care transitions, as well as time spent in the hospital and in a facility, compared with patients initially discharged home. Specialized models of care are needed in facilities caring for patients with LVADs.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Lander
authors.affiliation: Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Krishna
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Nordseth
authors.affiliation: Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH; Center for Connected Care, Cleveland Clinic, Cleveland, OH. Electronic address: Gorodee@ccf.org.
authors.forename: Eiran Z
authors.initials: EZ
authors.lastname: Gorodeski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D019467:Subacute Care; D018487:Ventricular Dysfunction, Left / Q000601:surgery*; D055815:Young Adult
keywords: Heart failure; left ventricular assist device; post-acute care; readmission