21 Mar Readmissions After LVAD For Heart Failure High, Mostly For Non-Cardiac Causes
MedicalResearch.com Interview with:
Dr. Sahil Agrawal, MBBS MD
Division of Cardiology, St. Luke’s University Health Network, Bethlehem, PA
Dr Lohit Garg MD
Division of Cardiology
Lehigh Valley Health Network, Allentown
MedicalResearch.com: What is the background for this study?
Response: Readmissions among advanced heart failure patients are common and contribute significantly to heath care related costs. Rates and causes of readmissions, and their associated costs among patients after durable left ventricular assist device (LVAD) implantation have not been studied in a contemporary multi-institutional setting. We studied the incidence, predictors, causes, and costs of 30-day readmissions after LVAD implantation using Nationwide Readmissions Database (NRD) in our recently published study.
MedicalResearch.com: What are the main findings?
Response: We observed that 30-day readmissions rates among LVAD patients remain high (31%) and are mostly secondary to non-cardiac causes (Infections and gastrointestinal bleeding). Length of index hospitalization ≥31 days and female sex were associated with a higher risk of 30-day readmission, whereas private insurance, pre-LVAD use of short-term mechanical circulatory support and discharge to a short-term hospital facility were associated with a lower risk. The mean length of stay for readmission was 10.7 days and average hospital cost per readmission was approximately $35,000.
MedicalResearch.com: What should readers take away from your report?
Response: Gastrointestinal bleeding and infections continue to be the most common causes of readmissions after LVAD implantation. Careful monitoring of anticoagulation along with patient and caretaker education will be of paramount importance to curtail these adverse events. The widespread availability of post discharge ancillary care such as visiting nurses, patient educators and rehabilitation services can be expected to positively impact readmissions especially in those at higher risk as identified in our study.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The future research should focus on interventions to reduce the 30-day readmissions after LVAD implantation including but not limited to pre-LVAD mechanical circulatory support, interdisciplinary team approach and widely available post discharge ancillary care.
No disclosures and no relevant conflict of interest.
Citations:
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
https://doi.org/10.1161/CIRCHEARTFAILURE.117.004628
Circulation: Heart Failure. 2018;11:e004628
Originally published March 8, 2018
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Last Updated on March 21, 2018 by Marie Benz MD FAAD