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Contemporary Trends of Clinical Outcomes in Primary Left Ventricular Assist Device Implantation and Postprocedure High-Risk Categories

Published:November 08, 2021DOI:https://doi.org/10.1016/j.cardfail.2021.07.017

      Highlights

      • Primary left ventricular assist device implantation was associated with 30.6% readmission within 30 days.
      • The trend of 30-day readmission did not changed from 2010 to 2018.
      • Primary left ventricular assist device implantation was associated with a 12.3% in-hospital mortality.
      • The trend of in-hospital mortality decreased from 2010 to 2018.
      • Patients in high-risk groups were associated with significantly higher mortality and resource use and 30-day readmission.
      • Medicare, urban hospitals, patient discharged to skilled nursing facility, and longer length of index hospital stay were predictors of higher 30-day readmission.

      Abstract

      Objective

      We aimed to analyze trends of 30-day readmission and find high-risk patients associated with increased risk of mortality, resource use, and readmission after primary left ventricular assist device (LVAD) implantation. Limited data exist on the contemporary trends of readmission rates and patients at a higher risk of worse outcomes after LVAD implantation.

      Methods and Results

      This is a retrospective study of adults from the Nationwide Readmission Database who underwent primary durable LVAD implantation from 2010 to 2018. The main outcomes were 30-day readmission rates and their trends in patients with primary durable LVAD implantation from 2010 to 2018. This study also sought to identify patients at the highest risk for readmission, in-hospital mortality, and resource use. A total of 31,002 adults with primary durable LVAD implantation were included in the present analysis. Overall, 3808 patients (12.3%) died and 27,168 (87.6%) were discharged alive. Of those discharged alive, 8303 patients (30.6%) were readmitted within 30 days. The trend of 30-day all-cause readmission among LVAD implantation patients remained similar from 2010 to 2018 (P = .809). The in-hospital mortality rate during the index hospitalization decreased significantly (P = .014), and the mean cost of an index hospitalization increased (P = .031) during the study period. The patients with post-LVAD in-hospital cardiac, vascular, and thromboembolic complications (ie, high-risk patients) had the highest mortality, resource use, and readmission rates compared with patients without major complications.

      Conclusions

      This study found that the readmission rates associated with LVAD implantation did not change from 2010 to 2018 and identified high-risk patients who may benefit from closer monitoring after primary LVAD implantation.

      Graphical abstract

      Key Words

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