Impact Of Atrial Fibrillation On Readmission After LVAD Implantation: Insight From National Readmission Database.

Abstract

<h3>Background</h3> The use of left ventricular assist devices (LVADs) in patients with advanced end-stage heart failure (HF) either as destination therapy or bridge to transplant has been growing over the last decades. Unfortunately, up to a third of these patients still experience poor outcomes following LVAD implantation. Arrhythmias is considered as one of the challenges in those patients. Atrial fibrillation (AF) remains the most common rhythm abnormality in advanced HF patients. We evaluated effect of AF on readmission after LVAD implantation. <h3>Methods</h3> We used the Nationwide Readmission Database (NRD), identifying patients who underwent implantable LVAD placement between 2014-2017 using ICD-9 and 10 codes. Patients were classified into 2 mutually exclusive groups based on presence of AF. Outcomes were all-cause and cause-specific 30-day readmissions. Multivariable regression was conducted for 30 days readmission adjusting for patient demographics, hospital characteristics, and Elixhauser Comorbidity Index. <h3>Result</h3> We identified 7,001 recipients, 2566 with AF and 4436 without AF diagnosis. AF-LVAD patients were younger (mean age: 51.3 ± 0.5 years) than non-AF LVAD patients (59 ± 0.4 years, P-value<0.001). History of a prior MI was more prevalent among AF-LVAD recipients when compared to non-AF LVAD patients (20% vs15.5%, respectively, P=0.007). Obstructive sleep apnea was more common among AF group when compared to non-AF group (14% vs 10%, respectively, P=0.028). There was no difference in terms of readmissions within 30 days between AF- LVAD 741 (28.8%) recipients and non-AF LVAD recipients 1273 (28.6%), also both groups have similar odds ratios of 30-day readmission (OR=0.99, P=0.941). Furthermore, there was no difference between AF and non-AF group in all-cause mortality at 30 days (5% vs 3%, P=0.184); risk of thromboembolism including stroke (2.5% vs 1.6%, P=0.501), pump thrombosis (9% vs 9.3%, P=0.921); major bleeding including GI bleeding (22.1% vs 18.1%, P=0.138) or intracranial bleeding (3.9% vs 2%, P=0.056). However, AF LVAD recipients were at significantly increased risk of readmission for acute heart failure exacerbation (32.5% vs 25.2%, P=0.04). <h3>Conclusion</h3> Our analysis suggests that AF among LVAD recipients has no impact on either 30-day readmission or 30-day mortality rates. Furthermore, AF was not associated with increased of stroke, pump thrombosis, major GI, or intracranial bleeding. However, AF LVAD patients are at increased risk of HF exacerbation.