(527) - Cerebrovascular Accidents and End of Life Admissions Contribute Most to the Cost in Patients With Continuous Flow Left Ventricular Assist Devices

Abstract

PurposeContinuous flow Left ventricular assist devices (LVAD) have proven to prolong life and quality of life in patients with end stage heart failure. However their cost effectiveness is still low compared to life prolonging therapies for other medical conditions. It is well known that the device and implantation contributes to the cost, but the contribution of readmissions to the overall cost is unknown.MethodsWe retrospectively reviewed the readmission cost (in US Dollars) during the first year after implant of continuous flow device in 119 patients during years 2008-11 at The Methodist Hospital, Houston. There were a total of 226 readmissions during that time period (1-year post implant or death). Kruskal-Wallis one way ANOVA was used to compare differences between groups.ResultsThere were 14 admissions for cerebrovascular accidents (CVA), 36 for gastrointestinal (GI) bleeding, 67 for infections, 10 for arrhythmias, 27 for heart failure, 9 for VAD related mechanical issues, and 63 admissions for other medical problems. Average cost of readmission, cost per day and length of stay for each medical reason is given in Table. Stroke related readmission costs were significantly higher compared to all other conditions (Table).Twelve of 16 patients who expired after index implant admission, during the first year of follow up, died in our hospital. Admissions leading to demise were considerably expensive compared to any other hospital admission (USD 428,843+/-383,687 vs. 95023+/-56,888; p<0.0001).Conclusion PurposeContinuous flow Left ventricular assist devices (LVAD) have proven to prolong life and quality of life in patients with end stage heart failure. However their cost effectiveness is still low compared to life prolonging therapies for other medical conditions. It is well known that the device and implantation contributes to the cost, but the contribution of readmissions to the overall cost is unknown. Continuous flow Left ventricular assist devices (LVAD) have proven to prolong life and quality of life in patients with end stage heart failure. However their cost effectiveness is still low compared to life prolonging therapies for other medical conditions. It is well known that the device and implantation contributes to the cost, but the contribution of readmissions to the overall cost is unknown. MethodsWe retrospectively reviewed the readmission cost (in US Dollars) during the first year after implant of continuous flow device in 119 patients during years 2008-11 at The Methodist Hospital, Houston. There were a total of 226 readmissions during that time period (1-year post implant or death). Kruskal-Wallis one way ANOVA was used to compare differences between groups. We retrospectively reviewed the readmission cost (in US Dollars) during the first year after implant of continuous flow device in 119 patients during years 2008-11 at The Methodist Hospital, Houston. There were a total of 226 readmissions during that time period (1-year post implant or death). Kruskal-Wallis one way ANOVA was used to compare differences between groups. ResultsThere were 14 admissions for cerebrovascular accidents (CVA), 36 for gastrointestinal (GI) bleeding, 67 for infections, 10 for arrhythmias, 27 for heart failure, 9 for VAD related mechanical issues, and 63 admissions for other medical problems. Average cost of readmission, cost per day and length of stay for each medical reason is given in Table. Stroke related readmission costs were significantly higher compared to all other conditions (Table).Twelve of 16 patients who expired after index implant admission, during the first year of follow up, died in our hospital. Admissions leading to demise were considerably expensive compared to any other hospital admission (USD 428,843+/-383,687 vs. 95023+/-56,888; p<0.0001). There were 14 admissions for cerebrovascular accidents (CVA), 36 for gastrointestinal (GI) bleeding, 67 for infections, 10 for arrhythmias, 27 for heart failure, 9 for VAD related mechanical issues, and 63 admissions for other medical problems. Average cost of readmission, cost per day and length of stay for each medical reason is given in Table. Stroke related readmission costs were significantly higher compared to all other conditions (Table).Twelve of 16 patients who expired after index implant admission, during the first year of follow up, died in our hospital. Admissions leading to demise were considerably expensive compared to any other hospital admission (USD 428,843+/-383,687 vs. 95023+/-56,888; p<0.0001). Conclusion