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Use of Post-acute Care Services and Readmissions After Left Ventricular Assist Device Implantation in Privately Insured Patients

      Highlights

      • More than one-third of patients use post-acute care services after LVAD surgery.
      • Patients cared for in larger hospitals, in more populated areas, and in the northeastern United States are more likely to use post-acute care after LVAD.
      • Patients with diabetes, peripheral vascular disease, and those with longer hospital length of stay for LVAD surgery are at highest risk for readmission, but post-acute care use is not associated with differential readmission risk.

      Abstract

      Background

      Very little is known about health care resource utilization, including post–acute care use and hospital readmissions, after left ventricular assist device (LVAD) implantation.

      Methods and Results

      Administrative claims from a database of multiple United States health plans were used to identify patients that received an LVAD (ICD-9 code 37.66) and survived to hospital discharge from January 1–2006, through September 30–2013. Post–acute care use was defined as a skilled nursing facility or rehabilitation stay within 90 days after hospital discharge. Patients were censored at heart transplantation or end of coverage through December 31–2013. Of 583 patients (mean age 55 years, 77% male), 223 (38.3%) used post–acute care services, more commonly in patients with diabetes, who required hemodialysis, and who had LVADs implanted at hospitals in more populated areas, with more beds, and in the northeast region (P < .05 for each). The most common reasons for readmission were device complications, heart failure, and arrhythmia. Readmission risk was higher in patients who had diabetes, peripheral vascular disease, and longer hospital length of stay, but it did not differ by post-acute care use.

      Conclusions

      Use of post-acute care services varies based on hospital characteristics. We found no association between post-acute care use and readmission risk after LVAD implantation.

      Key Words

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      References

        • Khazanie P.
        • Hammill B.G.
        • Patel C.B.
        • Eapen Z.J.
        • Peterson E.D.
        • Rogers J.G.
        • et al.
        Trends in the use and outcomes of ventricular assist devices among medicare beneficiaries, 2006 through 2011.
        J Am Coll Cardiol. 2014; 63: 1395-1404
        • Lampropulos J.F.
        • Kim N.
        • Wang Y.
        • Desai M.M.
        • Barreto-Filho J.A.
        • Dodson J.A.
        • et al.
        Trends in left ventricular assist device use and outcomes among Medicare beneficiaries, 2004–2011.
        Open Heart. 2014; 1: e000109
        • Forest S.J.
        • Bello R.
        • Friedmann P.
        • Casazza D.
        • Nucci C.
        • Shin J.J.
        • et al.
        Readmissions after ventricular assist device: etiologies, patterns, and days out of hospital.
        Ann Thorac Surg. 2013; 95: 1276-1281
        • Hasin T.
        • Marmor Y.
        • Kremers W.
        • Topilsky Y.
        • Severson C.J.
        • Schirger J.A.
        • et al.
        Readmissions after implantation of axial flow left ventricular assist device.
        J Am Coll Cardiol. 2013; 61: 153-163
        • Smedira N.G.
        • Hoercher K.J.
        • Lima B.
        • Mountis M.M.
        • Starling R.C.
        • Thuita L.
        • et al.
        Unplanned hospital readmissions after Heartmate II implantation: frequency, risk factors, and impact on resource use and survival.
        JACC Heart Fail. 2013; 1: 31-39
        • English M.L.
        • Speed J.
        Effectiveness of acute inpatient rehabilitation after left ventricular assist device placement.
        Am J Phys Med Rehabil. 2013; 92: 621-626
        • Lipska K.J.
        • Ross J.S.
        • Van Houten H.K.
        • Beran D.
        • Yudkin J.S.
        • Shah N.D.
        Use and out-of-pocket costs of insulin for type 2 diabetes mellitus from 2000 through 2010.
        JAMA. 2014; 311: 2331-2333
        • Wallace P.J.
        • Shah N.D.
        • Dennen T.
        • Bleicher P.A.
        • Crown W.H.
        Optum Labs: building a novel node in the learning health care system.
        Health Aff (Millwood). 2014; 33: 1187-1194
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Koroukian S.M.
        • Xu F.
        • Murray P.
        Ability of Medicare claims data to identify nursing home patients: a validation study.
        Med Care. 2008; 46: 1184-1187
        • Mechanic R.
        Post-acute care—the next frontier for controlling Medicare spending.
        N Engl J Med. 2014; 370: 692-694
        • Alsara O.
        • Reeves R.K.
        • Pyfferoen M.D.
        • Trenary T.L.
        • Englan D.J.
        • Vitse M.L.
        • et al.
        Inpatient rehabilitation improves outcomes for patients receiving left ventricular assist device.
        Inpatient Rehab Funct Improvement. 2014; 93: 860-868
        • Jencks S.F.
        • Williams M.V.
        • Coleman E.A.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        N Engl J Med. 2009; 360: 1418-1428
        • Dunlay S.M.
        • Weston S.A.
        • Killian J.M.
        • Bell M.R.
        • Jaffe A.S.
        • Roger V.L.
        Thirty-day rehospitalizations after acute myocardial infarction: a cohort study.
        Ann Intern Med. 2012; 157: 11-18
        • Hannan E.L.
        • Zhong Y.
        • Lahey S.J.
        • Culliford A.T.
        • Gold J.P.
        • Smith C.R.
        • et al.
        30-day readmissions after coronary artery bypass graft surgery in New York State.
        JACC Cardiovasc Interv. 2011; 4: 569-576
        • Kirklin J.K.
        • Naftel D.C.
        • Pagani F.D.
        • Kormos R.L.
        • Stevenson L.W.
        • Blume E.D.
        • et al.
        Sixth INTERMACS annual report: a 10,000-patient database.
        J Heart Lung Transplant. 2014; 33: 555-564