Comparison of LVAD Admissions Before and During the Era of COVID-19

Abstract

PurposeLVADs have improved survival and quality of life in advanced heart failure (HF) patients. However, post implant hospitalization rates remain higher than ideal, potentially impacting patient access and scarce resource utilization during COVID-19. This study examines the number of hospitalizations, causes, and length of stay (LOS) during the COVID-19 era.MethodsA retrospective review of 504 LVAD admissions from 9/2018 to 8/2021 was conducted. Admissions were divided into two-time periods each 18 months long: (a) Before COVID (9/2018 to 2/2020) and (b) during COVID (3/2020 to 8/2021). Admissions for cardiac transplantation were excluded. Admission rates (as events per patient-year, EPPY) were assessed as were the causes of admission with a 20% change (Delta, ∆) between eras considered clinically meaningful.ResultsA total of 153 patients were hospitalized with 504 total admissions. 274 (54.4%) were before COVID and 230 (45.6%) were during COVID. Overall LVAD admissions during the COVID era were lower (1.46 vs 1.63 admissions/patient-year, Table 1). During the COVID era, the risk of hospitalizations related to arrhythmias, device problems (low flow or device malfunction), and non-GI bleeding was increased by 60%, 40% and 21% respectively. At the same time, risk of admissions for gastrointestinal bleeding (GIB) and HF were lower by 20% and 33%, respectively. Average LOS between groups was not significantly different (p=0.21).ConclusionOverall unplanned LVAD admission rates in the COVID era were decreased. Those admissions that could not readily be managed in the outpatient domain for arrhythmias, device problems, and bleeding (non-GIB) were higher. However, GI bleeding (GIB) and heart failure (HF) hospitalizations were lower in the COVID era, likely related to extraordinary efforts to manage such adverse events in the outpatient setting or due to patient behavior changes during periods of quarantine. Other explanations appear less likely given that device use and outpatient management were similar between these 2 eras.