Abstract 19067: Rehospitalization Characteristics in Patients With Continuous Flow Left Ventricular Assist Devices

Abstract

Background: Readmission diagnoses, timing and hospital length of stay have become a major clinical and health policy focus in the management of patients with continuous flow left ventricular assist devices (CF-LVADs). The aim of this study was to characterize CF-LVAD rehospitalizations at a large volume center. Methods: We performed a retrospective analysis of patients implanted with HeartMate II (Thoratec, Pleasanton, CA) CF-LVADs from March 31, 2004 to September 20, 2012. Readmission metrics were evaluated in discharged patients following CF-LVAD placement as either a bridge to transplant (BTT) or destination therapy (DT) strategy. Data are reported as median and interquartile range, unless otherwise stated. Results: HeartMate II CF-LVADs were implanted in 205 patients (BTT 150; DT 55). Total time on LVAD support was 247.0 yrs (BTT 147.4 yrs; DT 99.6 yrs). Of 741 non-transplant readmissions, the majority were due to cardiac (BTT 27%; DT 24%), bleeding (BTT 12%; DT 29%), infection (BTT 19%; DT 11%) and device (BTT 12%; DT 9%) related diagnoses. Freedom from readmission at 30 days post-discharge following device implantation was 73.5% (SE 0.03). Table 1 lists 30 day and 1 yr event rates for common readmission diagnoses. DT patients had significantly higher 1 yr gastrointestinal bleeding (GIB) event rates than BTT (0.41 vs 0.21, p<0.01). Median length of stay per readmitting diagnosis included drive-line infection (10.5 days (6.8-17.0)); heart failure (9.5 days (5.0-15.0)); device malfunction (7.0 days (2.0-18.8)); and GIB (7.0 days (3.0-11.0)) for all CF-LVAD patients. Conclusion: Readmissions following CF-LVAD implantation are frequent and consume significant hospital inpatient time. Bleeding, cardiac, infection, and device related diagnoses contribute to the greatest burden of CF-LVAD rehospitalizations.