Thirty-Day Readmissions After Left Ventricular Assist Device Implantation in the United States: Insights From the Nationwide Readmissions Database

Sahil Agrawal, Lohit Garg, Mahek Shah, Manyoo Agarwal, Brijesh Patel, Amitoj Singh, Aakash Garg, Ulrich P. Jorde, Navin K. Kapur

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Early readmissions contribute significantly to heart failure-related morbidity and negatively affect quality of life. Data on left ventricular assist device (LVAD)-related 30-day readmissions are scarce and limited to small studies. METHODS AND RESULTS: Patients undergoing LVAD implantation between January 2013 and November 2014 who survived the index hospitalization were identified in the Nationwide Readmissions Database. We analyzed the incidence, predictors, causes, and costs of 30-day readmissions. Of 2510 LVAD recipients, 788 (31%) were readmitted within 30 days. Length of index hospitalization ≥31 days (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.07-1.50) and female sex (HR, 1.19; 95% CI, 1.01-1.42) were associated with a higher risk of 30-day readmission, whereas private insurance (HR, 0.83; 95% CI, 0.70-0.99), pre-LVAD use of short-term mechanical circulatory support (HR, 0.53; 95% CI, 0.29-0.98), and discharge to a short-term hospital facility (HR, 0.41; CI, 0.21-0.78) were associated with a lower risk. Cardiac causes accounted for 23.8% of readmissions: heart failure (13.4%) and arrhythmias (8.1%). Noncardiovascular causes accounted for 76.2% of readmissions: infection (30.2%), bleeding (17.6%), and device-related causes (8.2%). Mean length of stay for readmission was 10.7 days (median, 6 days), and average hospital cost per readmission was $34 948±2457. CONCLUSIONS: Early readmissions are frequent after LVAD implantation even in contemporary times. Preimplant identification of high-risk patients, and a protocol-driven follow-up using a multidisciplinary approach will be needed to reduce readmissions and improve outcomes.

Original languageEnglish (US)
Pages (from-to)e004628
JournalCirculation. Heart failure
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2018
Externally publishedYes

Fingerprint

Heart-Assist Devices
Databases
Confidence Intervals
Hospitalization
Heart Failure
Hospital Costs
Sex Ratio
Insurance
Cardiac Arrhythmias
Length of Stay
Quality of Life
Hemorrhage
Morbidity
Costs and Cost Analysis
Equipment and Supplies
Incidence
Infection

Keywords

  • heart failure
  • heart-assist devices
  • hospital costs
  • hospitalization
  • length of stay

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Thirty-Day Readmissions After Left Ventricular Assist Device Implantation in the United States : Insights From the Nationwide Readmissions Database. / Agrawal, Sahil; Garg, Lohit; Shah, Mahek; Agarwal, Manyoo; Patel, Brijesh; Singh, Amitoj; Garg, Aakash; Jorde, Ulrich P.; Kapur, Navin K.

In: Circulation. Heart failure, Vol. 11, No. 3, 01.03.2018, p. e004628.

Research output: Contribution to journalArticle

Agrawal, Sahil ; Garg, Lohit ; Shah, Mahek ; Agarwal, Manyoo ; Patel, Brijesh ; Singh, Amitoj ; Garg, Aakash ; Jorde, Ulrich P. ; Kapur, Navin K. / Thirty-Day Readmissions After Left Ventricular Assist Device Implantation in the United States : Insights From the Nationwide Readmissions Database. In: Circulation. Heart failure. 2018 ; Vol. 11, No. 3. pp. e004628.
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abstract = "BACKGROUND: Early readmissions contribute significantly to heart failure-related morbidity and negatively affect quality of life. Data on left ventricular assist device (LVAD)-related 30-day readmissions are scarce and limited to small studies. METHODS AND RESULTS: Patients undergoing LVAD implantation between January 2013 and November 2014 who survived the index hospitalization were identified in the Nationwide Readmissions Database. We analyzed the incidence, predictors, causes, and costs of 30-day readmissions. Of 2510 LVAD recipients, 788 (31{\%}) were readmitted within 30 days. Length of index hospitalization ≥31 days (hazard ratio [HR], 1.26; 95{\%} confidence interval [CI], 1.07-1.50) and female sex (HR, 1.19; 95{\%} CI, 1.01-1.42) were associated with a higher risk of 30-day readmission, whereas private insurance (HR, 0.83; 95{\%} CI, 0.70-0.99), pre-LVAD use of short-term mechanical circulatory support (HR, 0.53; 95{\%} CI, 0.29-0.98), and discharge to a short-term hospital facility (HR, 0.41; CI, 0.21-0.78) were associated with a lower risk. Cardiac causes accounted for 23.8{\%} of readmissions: heart failure (13.4{\%}) and arrhythmias (8.1{\%}). Noncardiovascular causes accounted for 76.2{\%} of readmissions: infection (30.2{\%}), bleeding (17.6{\%}), and device-related causes (8.2{\%}). Mean length of stay for readmission was 10.7 days (median, 6 days), and average hospital cost per readmission was $34 948±2457. CONCLUSIONS: Early readmissions are frequent after LVAD implantation even in contemporary times. Preimplant identification of high-risk patients, and a protocol-driven follow-up using a multidisciplinary approach will be needed to reduce readmissions and improve outcomes.",
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AU - Shah, Mahek

AU - Agarwal, Manyoo

AU - Patel, Brijesh

AU - Singh, Amitoj

AU - Garg, Aakash

AU - Jorde, Ulrich P.

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N2 - BACKGROUND: Early readmissions contribute significantly to heart failure-related morbidity and negatively affect quality of life. Data on left ventricular assist device (LVAD)-related 30-day readmissions are scarce and limited to small studies. METHODS AND RESULTS: Patients undergoing LVAD implantation between January 2013 and November 2014 who survived the index hospitalization were identified in the Nationwide Readmissions Database. We analyzed the incidence, predictors, causes, and costs of 30-day readmissions. Of 2510 LVAD recipients, 788 (31%) were readmitted within 30 days. Length of index hospitalization ≥31 days (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.07-1.50) and female sex (HR, 1.19; 95% CI, 1.01-1.42) were associated with a higher risk of 30-day readmission, whereas private insurance (HR, 0.83; 95% CI, 0.70-0.99), pre-LVAD use of short-term mechanical circulatory support (HR, 0.53; 95% CI, 0.29-0.98), and discharge to a short-term hospital facility (HR, 0.41; CI, 0.21-0.78) were associated with a lower risk. Cardiac causes accounted for 23.8% of readmissions: heart failure (13.4%) and arrhythmias (8.1%). Noncardiovascular causes accounted for 76.2% of readmissions: infection (30.2%), bleeding (17.6%), and device-related causes (8.2%). Mean length of stay for readmission was 10.7 days (median, 6 days), and average hospital cost per readmission was $34 948±2457. CONCLUSIONS: Early readmissions are frequent after LVAD implantation even in contemporary times. Preimplant identification of high-risk patients, and a protocol-driven follow-up using a multidisciplinary approach will be needed to reduce readmissions and improve outcomes.

AB - BACKGROUND: Early readmissions contribute significantly to heart failure-related morbidity and negatively affect quality of life. Data on left ventricular assist device (LVAD)-related 30-day readmissions are scarce and limited to small studies. METHODS AND RESULTS: Patients undergoing LVAD implantation between January 2013 and November 2014 who survived the index hospitalization were identified in the Nationwide Readmissions Database. We analyzed the incidence, predictors, causes, and costs of 30-day readmissions. Of 2510 LVAD recipients, 788 (31%) were readmitted within 30 days. Length of index hospitalization ≥31 days (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.07-1.50) and female sex (HR, 1.19; 95% CI, 1.01-1.42) were associated with a higher risk of 30-day readmission, whereas private insurance (HR, 0.83; 95% CI, 0.70-0.99), pre-LVAD use of short-term mechanical circulatory support (HR, 0.53; 95% CI, 0.29-0.98), and discharge to a short-term hospital facility (HR, 0.41; CI, 0.21-0.78) were associated with a lower risk. Cardiac causes accounted for 23.8% of readmissions: heart failure (13.4%) and arrhythmias (8.1%). Noncardiovascular causes accounted for 76.2% of readmissions: infection (30.2%), bleeding (17.6%), and device-related causes (8.2%). Mean length of stay for readmission was 10.7 days (median, 6 days), and average hospital cost per readmission was $34 948±2457. CONCLUSIONS: Early readmissions are frequent after LVAD implantation even in contemporary times. Preimplant identification of high-risk patients, and a protocol-driven follow-up using a multidisciplinary approach will be needed to reduce readmissions and improve outcomes.

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