Abstract 297: Trends in 1-year hospitalizations and costs from 2004 to 2010 among Medicare Fee-For-Service beneficiaries with LVADs

Abstract

Background: Short-term mortality among elderly Left Ventricular Assist Devices (LVADs) recipients has improved over time, yet LVADS are expensive and usually reserved for patients with severe heart failure with few other treatment options. Little is known about the long-term illness burden of these patients and how it has changed over time with improvements in LVAD technology. The aim of this study is to characterize the duration and cost of re-hospitalizations among elderly Medicare beneficiaries surviving one year post-LVAD implant from 2004-2010. Methods: We used inpatient National Claims History files from the Centers for Medicare and Medicaid Services (CMS) to identify 100% of fee-for-service (FFS) patients aged ≥65 years that received LVAD from 2004 to 2011 and were alive 1 year after discharge. The 2011 data was used for tracking the 1-year outcomes of 2010 patients. We censored patients that died within 1-year follow-up. We ascertained hospitalizations and in-hospital days through corresponding vital status files. Costs were defined as total health care facility payments made by Medicare per patient. Results: One year post-LVAD implantation, the proportion of living patients increased from 42% (n=45/107) in 2004 to 80% (n=348/433) in 2010. The proportion of patients readmitted decreased from 71% (n= 32/45) in 2004 to 61% (n=281/348) in 2010. The mean number of in-hospital days per patient hospitalized decreased from 30.2 days in 2004 to 20.8 days in 2010. Total CMS payments for all hospitalizations per patient increased from $50,111 in 2004 to $53,632 in 2010. Conclusions: From 2004 to 2010, more patients survived to 1 year after LVAD implant. Elderly patients spent a decreasing number of days in the hospital per patient with a slight increase in costs to Medicare. This reduction in hospital days suggests a decrease in LVAD morbidity over time that is complementary to the decline in mortality among this vulnerable group of LVAD recipients.