Abstract
INTRODUCTION: Left ventricular assist devices (LVADs) implantation is uprtending in patients with end stage heart failure. GI bleeding (GIB) is one the most common complication in patients with LVAD implantation. Thus, the aim is to analyze the temporal trends of GIB, mortality, length of stay and costs of LVAD related GIB. METHODS: This is a nationwide serial cross-sectional analysis. We queried the National Inpatient Sample (NIS) databases using International Classification of Diseases coding system to identify patients admitted with GI bleeding with or without LVAD from 2008 to 2017 in acute-care hospitals across the United State. Univariate and multivariate logistic-linear regression analysis was performed with STATA software. RESULTS: There were 3,107,471 discharges with a primary diagnosis of GI bleeding during the study period. There were total of 6,569 (8.36 % of all LVAD hospitalizations) admissions for patients with LVADs and a primary diagnosis of GI bleeding. For all patients, hospitalizations for a primary discharge diagnosis of GI bleeding increased by 29.8% (95% CI: 27.6-29.9, P < 0.001) from 2008 to 2017(Figure 1A). During the study period, the hospital admissions for patients with LVADs increased by 91.6% (95% CI: 90.4-93.6, P < 0.001). The trend analysis demonstrated that the increment in LVAD patients with upper GI bleeding was more pronounced than with lower GI bleeding (22.85 -fold vs. 21.67 -fold, P < 0.001). LOS increased by 2.53 days (95% CI: 1.78-2.98, P < 0.01), and mean hospital charge for each stay increased by $25,980(95% CI: 21,267-29,874, P < 0.01) and total charge by 150 million dollars (95% CI: 138-169 × 106, P < 0.01). CONCLUSION: GIB in patients with left ventricular assist devices is an important cause of morbidity and healthcare resource utilization in the United States. Its rising hospital admission warrants risk-based patient evaluation and careful implementation of management strategies in patients with advanced heart failure.Figure 1
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