Unplanned Readmission Burden Impacts Survival in Patients with Contemporary Continuous-Flow Left Ventricular Assist Device: STS Intermacs Analysis

Abstract

<h3>Purpose</h3> Survival on durable continuous-flow left ventricular assist device (CF-LVAD) now mirrors that of heart transplant patients. There is a paucity of data on how readmission burden impacts survival in such patients. This study aims to determine if readmission burden influences survival outcomes after contemporary CF-LVAD implant. <h3>Methods</h3> The STS Intermacs registry data were retrospectively evaluated for clinical outcomes in adults (≥18 years) with durable CF-LVAD implant between 1/2008-3/2020. Readmissions were defined as hemocompatibility-related adverse events (HRAE) vs non-HRAE (Table 1). A multiphase non-proportional hazard model with readmission as a time-varying covariate was used to analyze the impact of readmission on the risk of early (death predominant within first 6 months) and late hazard phases of death on CF-LVAD. <h3>Results</h3> 26,933 CF-LVAD adults (mean age 57 ± 13 years, 40% centrifugal, 49% destination therapy) had a median follow-up of 1.1 years [2.8 months, 3.4 years]. Overall 1 month and 5 year survival was 96% and 47%, respectively. 56,495 unplanned readmissions (23,617 HRAE and 32,057 non-HRAE) were observed in 17,221 patients. Most had one hospital readmission (31.5%). The cumulative number of overall, HRAE, and non-HRAE readmissions per patient were 0.83, 0.82 and 0.96 at 1 year and 5.7, 2.9 and 3.8 at 5 years, respectively. Unplanned readmission, along with frequency and length of stay (LOS) of non-HRAE was associated with a higher risk of late vs early death. Table 1 highlights the differential predictors associated with early and late death. <h3>Conclusion</h3> Most patients with contemporary CF-LVAD had at least one unplanned readmission. Unplanned readmission, along with predominantly frequency and LOS of non-HRAE, worsens the risk of late death. Future analyses should examine mitigation strategies to curb unplanned readmissions based on HRAE vs non-HRAE categorization.