Present-day hospital readmissions after left ventricular assist device implantation: A large single-center study

Ruben E. Hernandez, Steve K. Singh, Dale T. Hoang, Syed W. Ali, MacArthur A. Elayda, Hari R. Mallidi, O. H. Frazier, Deborah E. Meyers

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)419-429
Number of pages11
JournalTexas Heart Institute Journal
Volume42
Issue number5
DOIs
StatePublished - Oct 2015
Externally publishedYes

Keywords

  • Comorbidity
  • Diabetes complications/epidemiology/mortality/surgery
  • Heart failure/therapy
  • Heart-assist devices
  • Hospital readmission
  • Hospitalization/statistics and numerical data
  • Left ventricular assist device
  • Patient readmission/statistics and numerical data
  • Retrospective studies
  • Surgical wound infections
  • Thrombosis
  • Treatment outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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