Optimal Hemodynamics During Left Ventricular Assist Device Support Are Associated With Reduced Readmission Rates

Teruhiko Imamura, Valluvan Jeevanandam, Gene Kim, Jayant Raikhelkar, Nitasha Sarswat, Sara Kalantari, Bryan Smith, Daniel Rodgers, Stephanie Besser, Ben Chung, Ann Nguyen, Nikhil Narang, Takeyoshi Ota, Tae Song, Colleen Juricek, Mandeep Mehra, Maria Rosa Costanzo, Ulrich P. Jorde, Daniel Burkhoff, Gabriel SayerNir Uriel

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: Left ventricular assist device (LVAD) therapy improves the hemodynamics of advanced heart failure patients. However, it is unknown whether hemodynamic optimization improves clinical outcomes. The aim of this study was to investigate whether hemodynamic optimization reduces hospital readmission rate in LVAD patients. METHODS AND RESULTS: LVAD patients undergoing an invasive hemodynamic ramp test were prospectively enrolled and followed for 1 year. LVAD speed was optimized using a ramp test, targeting the following goals: central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <18 mm Hg, and cardiac index >2.2 L/(min·m2). The frequency and cause of hospital readmissions were compared between patients who achieved (optimized group) or did not achieve (nonoptimized group) these goals. Eighty-eight outpatients (median 61 years old, 53 male) underwent ramp testing 236 days after LVAD implantation, and 54 (61%) had optimized hemodynamics after LVAD speed adjustment. One-year survival after the ramp study was comparable in both groups (89% versus 88%). The total hospital readmission rate was lower in the optimized group compared with the nonoptimized group (1.15 versus 2.86 events/y, P<0.001). This result was predominantly because of a reduction in the heart failure readmission rate in the optimized group (0.08 versus 0.71 events/y, P=0.016). CONCLUSIONS: LVAD patients, in whom hemodynamics were optimized, had a significantly lower rate of hospital readmissions, primarily because of fewer heart failure admissions. These findings highlight the importance of achieving hemodynamic optimization in LVAD patients.

Original languageEnglish (US)
Pages (from-to)e005094
JournalCirculation. Heart failure
Volume12
Issue number2
DOIs
StatePublished - Feb 1 2019

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Heart-Assist Devices
Hemodynamics
Patient Readmission
Architectural Accessibility
Heart Failure
Central Venous Pressure
Outpatients
Survival

Keywords

  • blood pressure
  • central venous pressure
  • heart failure
  • hemodynamics
  • patients

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Optimal Hemodynamics During Left Ventricular Assist Device Support Are Associated With Reduced Readmission Rates. / Imamura, Teruhiko; Jeevanandam, Valluvan; Kim, Gene; Raikhelkar, Jayant; Sarswat, Nitasha; Kalantari, Sara; Smith, Bryan; Rodgers, Daniel; Besser, Stephanie; Chung, Ben; Nguyen, Ann; Narang, Nikhil; Ota, Takeyoshi; Song, Tae; Juricek, Colleen; Mehra, Mandeep; Costanzo, Maria Rosa; Jorde, Ulrich P.; Burkhoff, Daniel; Sayer, Gabriel; Uriel, Nir.

In: Circulation. Heart failure, Vol. 12, No. 2, 01.02.2019, p. e005094.

Research output: Contribution to journalArticle

Imamura, T, Jeevanandam, V, Kim, G, Raikhelkar, J, Sarswat, N, Kalantari, S, Smith, B, Rodgers, D, Besser, S, Chung, B, Nguyen, A, Narang, N, Ota, T, Song, T, Juricek, C, Mehra, M, Costanzo, MR, Jorde, UP, Burkhoff, D, Sayer, G & Uriel, N 2019, 'Optimal Hemodynamics During Left Ventricular Assist Device Support Are Associated With Reduced Readmission Rates', Circulation. Heart failure, vol. 12, no. 2, pp. e005094. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005094
Imamura, Teruhiko ; Jeevanandam, Valluvan ; Kim, Gene ; Raikhelkar, Jayant ; Sarswat, Nitasha ; Kalantari, Sara ; Smith, Bryan ; Rodgers, Daniel ; Besser, Stephanie ; Chung, Ben ; Nguyen, Ann ; Narang, Nikhil ; Ota, Takeyoshi ; Song, Tae ; Juricek, Colleen ; Mehra, Mandeep ; Costanzo, Maria Rosa ; Jorde, Ulrich P. ; Burkhoff, Daniel ; Sayer, Gabriel ; Uriel, Nir. / Optimal Hemodynamics During Left Ventricular Assist Device Support Are Associated With Reduced Readmission Rates. In: Circulation. Heart failure. 2019 ; Vol. 12, No. 2. pp. e005094.
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abstract = "BACKGROUND: Left ventricular assist device (LVAD) therapy improves the hemodynamics of advanced heart failure patients. However, it is unknown whether hemodynamic optimization improves clinical outcomes. The aim of this study was to investigate whether hemodynamic optimization reduces hospital readmission rate in LVAD patients. METHODS AND RESULTS: LVAD patients undergoing an invasive hemodynamic ramp test were prospectively enrolled and followed for 1 year. LVAD speed was optimized using a ramp test, targeting the following goals: central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <18 mm Hg, and cardiac index >2.2 L/(min·m2). The frequency and cause of hospital readmissions were compared between patients who achieved (optimized group) or did not achieve (nonoptimized group) these goals. Eighty-eight outpatients (median 61 years old, 53 male) underwent ramp testing 236 days after LVAD implantation, and 54 (61{\%}) had optimized hemodynamics after LVAD speed adjustment. One-year survival after the ramp study was comparable in both groups (89{\%} versus 88{\%}). The total hospital readmission rate was lower in the optimized group compared with the nonoptimized group (1.15 versus 2.86 events/y, P<0.001). This result was predominantly because of a reduction in the heart failure readmission rate in the optimized group (0.08 versus 0.71 events/y, P=0.016). CONCLUSIONS: LVAD patients, in whom hemodynamics were optimized, had a significantly lower rate of hospital readmissions, primarily because of fewer heart failure admissions. These findings highlight the importance of achieving hemodynamic optimization in LVAD patients.",
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AU - Sarswat, Nitasha

AU - Kalantari, Sara

AU - Smith, Bryan

AU - Rodgers, Daniel

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AU - Mehra, Mandeep

AU - Costanzo, Maria Rosa

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N2 - BACKGROUND: Left ventricular assist device (LVAD) therapy improves the hemodynamics of advanced heart failure patients. However, it is unknown whether hemodynamic optimization improves clinical outcomes. The aim of this study was to investigate whether hemodynamic optimization reduces hospital readmission rate in LVAD patients. METHODS AND RESULTS: LVAD patients undergoing an invasive hemodynamic ramp test were prospectively enrolled and followed for 1 year. LVAD speed was optimized using a ramp test, targeting the following goals: central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <18 mm Hg, and cardiac index >2.2 L/(min·m2). The frequency and cause of hospital readmissions were compared between patients who achieved (optimized group) or did not achieve (nonoptimized group) these goals. Eighty-eight outpatients (median 61 years old, 53 male) underwent ramp testing 236 days after LVAD implantation, and 54 (61%) had optimized hemodynamics after LVAD speed adjustment. One-year survival after the ramp study was comparable in both groups (89% versus 88%). The total hospital readmission rate was lower in the optimized group compared with the nonoptimized group (1.15 versus 2.86 events/y, P<0.001). This result was predominantly because of a reduction in the heart failure readmission rate in the optimized group (0.08 versus 0.71 events/y, P=0.016). CONCLUSIONS: LVAD patients, in whom hemodynamics were optimized, had a significantly lower rate of hospital readmissions, primarily because of fewer heart failure admissions. These findings highlight the importance of achieving hemodynamic optimization in LVAD patients.

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