Frequency of Unplanned Hospital Readmissions and Impact on Survival in HeartMate3 (HM3) Patients

Abstract

<h3>Purpose</h3> Unplanned readmissions were common during second generation LVAD support and negatively impacted survival. We investigated frequency and indication for unplanned readmissions and their association with survival during contemporary HM3 support. <h3>Methods</h3> We retrospectively reviewed all pts who underwent HM3 implantation between 11/26/14 and 12/4/19 and survived to hospital discharge. All unplanned readmissions up to 900 days of followup were analyzed. Readmissions were categorized based INTERMACS criteria into: major bleeding, infection, arrhythmia, volume overload, device-related complications and other causes. Freedom from 1, 2, 3, ≥4 readmissions was evaluated by KM method. The impact of frequency of unplanned readmissions on survival was evaluated by conditional survival analysis. Factors associated with readmissions were evaluated by Fine-Gray Cox subdistribution. <h3>Results</h3> There were 393 readmissions in 182 HM3 pts: age 61.2(52.5,69)yrs; 16.5% female; 63.7% INTERMACS profile 1/2; 38.5% ischemic. 57(31.3%) pts had 0, 36(19.8%) had 1, 31(17.0%) 2, 16(8.8%) 3 and 22(23.1%) ≥4 readmissions during the follow-up. Reason for readmissions were: infection (30.0%), major bleeding (13.7%), arrhythmia (9.7%), volume overload (6.4%), device-related complications (13.0%) and other causes (27.2%). Need for RVAD during the index admission was the only risk factor associated with risk of readmission, HR1.53[1.06-2.21]. 1-year freedom from 1, 2, 3, ≥4 readmissions was 41%, 64%, 77%, 79%, respectively (<b>Fig 1A</b>). 900-days survival after discharge from index implant admission was similar in pts with and without readmissions, irrespective of their number, and overall >93% in all groups (<b>Fig 1B</b>). <h3>Conclusion</h3> Although unplanned readmissions remain frequent and recurring complications, they do not appear to impact survival in this cohort of HM3 pts. Further work to reduce excess hospital readmissions is warranted to improve quality of life, reduce costs and allow broader application of LVAD therapy.