Author + information
- Received November 1, 2012
- Accepted November 12, 2012
- Published online February 1, 2013.
- Nicholas G. Smedira, MD∗∗ (, )
- Katherine J. Hoercher, RN†,
- Brian Lima, MD∗,
- Maria M. Mountis, DO‡,
- Randall C. Starling, MD, MPH‡,
- Lucy Thuita, MS§,
- Darlene M. Schmuhl, RN† and
- Eugene H. Blackstone, MD∗,§
- ↵∗Reprint requests and correspondence:
Dr. Nicholas G. Smedira, Cleveland Clinic, 9500 Euclid Avenue, Desk J4-1, Cleveland, Ohio 44195.
Presented at the American College of Cardiology's 61st Annual Scientific Session in Chicago, March 24–27, 2012.
Objectives The purpose of this study was to identify potential areas for quality improvement and cost containment. We investigated readmissions after HeartMate II left ventricular assist device (LVAD) implantation by characterizing their type, temporal frequency, causative factors, and resource use and survival after readmission.
Background The HeartMate II LVAD provides enhanced survival and quality of life to end-stage heart failure patients. Whether these improved outcomes are accompanied by a similar reduction in unplanned hospital readmissions is largely unknown.
Methods From October 2004 to January 2010, 118 patients received a HeartMate II, of whom 92 were discharged on device support. Subsequent readmissions were analyzed using prospectively maintained clinical and financial databases.
Results Forty-eight patients (52%) had 177 unplanned hospital readmissions, 87 non–LVAD- and 90 LVAD-associated. Reasons for non–LVAD-associated readmissions included medical management of comorbidities and progression of cardiac pathology (n = 48), neuropsychiatric/psychosocial issues (n = 22), and infections (n = 17). Those for LVAD-associated readmissions included device component infection (n = 51), management of nontherapeutic anticoagulation or device malfunction (n = 22), and bleeding (n = 15). Cumulative incidence of unplanned readmissions was higher (p < 0.0001) for destination therapy than bridge-to-transplant patients (9/patient vs. 4/patient at 24 months). Cumulative hospital days overall were 25 and 42 at 12 and 18 months, respectively, and the costs were 18% and 29% of initial implantation costs. Increased number of unplanned readmissions was predictive of mortality.
Conclusions Unplanned readmissions are common during HeartMate II support and negatively affect resource use and survival. Refining patient selection, especially in destination therapy patients, reducing infectious and bleeding complications, and increasing awareness about these devices might reduce unnecessary readmissions.
This study was funded in part by the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research, held by Dr. Blackstone. Dr. Starling serves on the Thoratec Roadmap Trial steering committee. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 1, 2012.
- Accepted November 12, 2012.
- American College of Cardiology Foundation