title: Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in Gastrointestinal Bleeding.
abstract: Left ventricular assist devices (LVADs) are being utilized for management of end-stage heart failure and require systemic anticoagulation. Gastrointestinal bleeding (GIB) is one of the most common adverse events following LVAD implantation.
  
  
  
  To investigate the impact of continuous-flow (CF) LVAD implants on outcomes of patients admitted with GIB.
  
  
  
  This is a cross-sectional study utilizing the Nationwide Inpatient Sample in the CF-LVAD era from 2010 to 2012. All adult admissions with a primary diagnosis of GIB were included. Among hospitalizations with GIB, patients with (cases) and without (controls) CF-LVAD implants were compared using univariate and multivariate analyses. The main outcome measurements were in-hospital mortality, length of stay, and hospitalization costs.
  
  
  
  Among 1,002,299 hospitalizations for GIB, 1112 (0.11%) patients had CF-LVADs. Bleeding angiodysplasia accounted for a majority of GIB in CF-LVAD patients (35.4% of 1112). Multivariate analysis adjusting for demographic, hospital and etiological differences, site of GIB, and patient comorbidities revealed that CF-LVADs were not adversely associated with mortality in GIB (OR 0.53, 95% CI 0.07-4.15). However, CF-LVADs independently accounted for prolonged hospitalization (3.5 days, 95% CI 2.6-4.6) and higher hospital charges ($37,032, 95% CI $7991-$66,074).
  
  
  
  In patients admitted with GIB, CF-LVAD implantation accounts for higher healthcare utilization, but is not adversely associated with mortality despite therapeutic anticoagulation, increased comorbidities, and comparatively delayed endoscopy. These findings are relevant as CF-LVADs are the dominant type of LVAD and are associated with increased risk of GIB compared to their predecessors.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd Floor Office Tower, Columbus, OH, 43210, USA.
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, 241-2 Cunz Hall, 1841 Neil Ave., Columbus, OH, 43210, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Hinton
authors.affiliation: Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 3rd Floor Office Tower, Columbus, OH, 43210, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Nishaki K
authors.initials: NK
authors.lastname: Mehta
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd Floor Office Tower, Columbus, OH, 43210, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Eldika
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd Floor Office Tower, Columbus, OH, 43210, USA.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd Floor Office Tower, Columbus, OH, 43210, USA.
authors.forename: Hisham
authors.initials: H
authors.lastname: Hussan
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd Floor Office Tower, Columbus, OH, 43210, USA.
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd Floor Office Tower, Columbus, OH, 43210, USA. Sgkrishna@gmail.com.
authors.forename: Somashekar G
authors.initials: SG
authors.lastname: Krishna
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000191:economics / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants
keywords: Cardiovascular disease; Endoscopy; Gastrointestinal bleeding; Heart failure; Left ventricular assist devices