Sahil Agrawal1, Lohit Garg2, Mahek Shah2, Manyoo Agarwal2, Brijesh Patel2, Amitoj Singh2, Aakash Garg2, Ulrich P Jorde2, Navin K Kapur2. 1. From the Division of Cardiology, St. Luke's University Health Network, Bethlehem, PA (S.A.); Division of Cardiology, Lehigh Valley Health Network, Allentown, PA (L.G., M.S., B.P.); Department of Internal Medicine, University of Tennessee Health Science Center, Memphis (M.A.); Division of Non-Invasive Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.S.); Division of Cardiology, Newark Beth Israel Medical Center, NJ (A.G.); Division of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.); and The CardioVascular Center, Tufts Medical Center, Boston, MA (N.K.K.). sahilagrawal124@gmail.com. 2. From the Division of Cardiology, St. Luke's University Health Network, Bethlehem, PA (S.A.); Division of Cardiology, Lehigh Valley Health Network, Allentown, PA (L.G., M.S., B.P.); Department of Internal Medicine, University of Tennessee Health Science Center, Memphis (M.A.); Division of Non-Invasive Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.S.); Division of Cardiology, Newark Beth Israel Medical Center, NJ (A.G.); Division of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.); and The CardioVascular Center, Tufts Medical Center, Boston, MA (N.K.K.).
Abstract
BACKGROUND: Early readmissions contribute significantly to heart failure-related morbidity and negatively affect quality of life. Data on left ventricular assist device (LVAD)-related 30-day readmissions are scarce and limited to small studies. METHODS AND RESULTS: Patients undergoing LVAD implantation between January 2013 and November 2014 who survived the index hospitalization were identified in the Nationwide Readmissions Database. We analyzed the incidence, predictors, causes, and costs of 30-day readmissions. Of 2510 LVAD recipients, 788 (31%) were readmitted within 30 days. Length of index hospitalization ≥31 days (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.07-1.50) and female sex (HR, 1.19; 95% CI, 1.01-1.42) were associated with a higher risk of 30-day readmission, whereas private insurance (HR, 0.83; 95% CI, 0.70-0.99), pre-LVAD use of short-term mechanical circulatory support (HR, 0.53; 95% CI, 0.29-0.98), and discharge to a short-term hospital facility (HR, 0.41; CI, 0.21-0.78) were associated with a lower risk. Cardiac causes accounted for 23.8% of readmissions: heart failure (13.4%) and arrhythmias (8.1%). Noncardiovascular causes accounted for 76.2% of readmissions: infection (30.2%), bleeding (17.6%), and device-related causes (8.2%). Mean length of stay for readmission was 10.7 days (median, 6 days), and average hospital cost per readmission was $34 948±2457. CONCLUSIONS: Early readmissions are frequent after LVAD implantation even in contemporary times. Preimplant identification of high-risk patients, and a protocol-driven follow-up using a multidisciplinary approach will be needed to reduce readmissions and improve outcomes.
BACKGROUND: Early readmissions contribute significantly to heart failure-related morbidity and negatively affect quality of life. Data on left ventricular assist device (LVAD)-related 30-day readmissions are scarce and limited to small studies. METHODS AND RESULTS:Patients undergoing LVAD implantation between January 2013 and November 2014 who survived the index hospitalization were identified in the Nationwide Readmissions Database. We analyzed the incidence, predictors, causes, and costs of 30-day readmissions. Of 2510 LVAD recipients, 788 (31%) were readmitted within 30 days. Length of index hospitalization ≥31 days (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.07-1.50) and female sex (HR, 1.19; 95% CI, 1.01-1.42) were associated with a higher risk of 30-day readmission, whereas private insurance (HR, 0.83; 95% CI, 0.70-0.99), pre-LVAD use of short-term mechanical circulatory support (HR, 0.53; 95% CI, 0.29-0.98), and discharge to a short-term hospital facility (HR, 0.41; CI, 0.21-0.78) were associated with a lower risk. Cardiac causes accounted for 23.8% of readmissions: heart failure (13.4%) and arrhythmias (8.1%). Noncardiovascular causes accounted for 76.2% of readmissions: infection (30.2%), bleeding (17.6%), and device-related causes (8.2%). Mean length of stay for readmission was 10.7 days (median, 6 days), and average hospital cost per readmission was $34 948±2457. CONCLUSIONS: Early readmissions are frequent after LVAD implantation even in contemporary times. Preimplant identification of high-risk patients, and a protocol-driven follow-up using a multidisciplinary approach will be needed to reduce readmissions and improve outcomes.
Authors: Adam S Faye; Timothy Wen; Ashwin N Ananthakrishnan; Simon Lichtiger; Gilaad G Kaplan; Alexander M Friedman; Garrett Lawlor; Jason D Wright; Frank J Attenello; William J Mack; Benjamin Lebwohl Journal: Clin Gastroenterol Hepatol Date: 2019-07-20 Impact factor: 11.382
Authors: Palak Shah; Melana Yuzefpolskaya; Gavin W Hickey; Khadijah Breathett; Omar Wever-Pinzon; Van-Khue Ton; William Hiesinger; Devin Koehl; James K Kirklin; Ryan S Cantor; Jeffrey P Jacobs; Robert H Habib; Francis D Pagani; Daniel J Goldstein Journal: Ann Thorac Surg Date: 2022-01-07 Impact factor: 4.330
Authors: Sophia J Fanelli; Mohammed Elzeneini; Lauren E Meece; Ahmad Mahmoud; Eric I Jeng; Neil Harris; Mustafa M Ahmed Journal: J Card Surg Date: 2022-05-24 Impact factor: 1.778
Authors: Michael J Pienta; Xiaoting Wu; Thomas M Cascino; Alexander A Brescia; Ashraf Abou El Ela; Min Zhang; Jeffrey S McCullough; Supriya Shore; Keith D Aaronson; Michael P Thompson; Francis D Pagani; Donald S Likosky Journal: Ann Thorac Surg Date: 2022-02-15 Impact factor: 5.102
Authors: Murat Sezgin; Murat Bülent Rabuş; Emre Selçuk; Özge Altaş; Sabit Sarıkaya; Mehmet Balkanay; Mehmet Kaan Kırali Journal: Turk Gogus Kalp Damar Cerrahisi Derg Date: 2020-01-23 Impact factor: 0.332