Impact of Patient Distance From Ventricular Assist Device-Implanting Center on Short- and Long-Term Outcomes

Ashwin K. Ravichandran, Palak Shah, Ramesh Singh, Keith D. Aaronson, Francis D. Pagani, John Stulak, Shannon M Dunlay, Todd F. Dardas, Nahush A. Mokadam, Christopher T. Salerno, Jennifer A. Cowger

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Highly specialized left ventricular assist device care is not readily available in many areas, potentially limiting access to therapy. This retrospective analysis examines the relationship of outcomes by patient distance from implanting left ventricular assist device center within the Mechanical Circulatory Support Research Network. Zip codes were used to calculate patient distance, with the primary outcome of interest being 3-year survival by distance from the surgical center. Secondary outcomes included 90-day survival and incident event rates for the following: gastrointestinal bleeding, infection, cerebral event, and pump thrombosis. Across the four centers, there were 1184 patients supported for a median of 486 days. Overall survival was 91 ± 0.8% at 90 days and 61 ± 1.9% at 3 years, with worse 3-year survival in those living >90 vs. ≤90 miles from the ventricular assist device implant center (55 ± 3.0% vs. 64 ± 2.5, p = 0.019). Patients living >90 miles from an implant center were older, more likely to be implanted for destination therapy support, had a prior sternotomy, and had worse renal function than those living closer (p <0.05 for all). After adjusting for these factors, albumin and center of implant, the hazard ratio did not reach statistical significance (hazard ratio = 1.2; p = 0.14). Except for gastrointestinal bleeding, the event rates for the secondary outcomes were higher for those living closer to the implanting center. Protocols should be designed for more frequent follow-up and increased shared care opportunities to ensure optimal outcomes are achieved in distant patients.

Original languageEnglish (US)
Pages (from-to)721-726
Number of pages6
JournalASAIO journal (American Society for Artificial Internal Organs : 1992)
Volume64
Issue number6
DOIs
StatePublished - Nov 1 2018

Fingerprint

Left ventricular assist devices
Heart-Assist Devices
Hazards
Survival
Albumins
Pumps
Hemorrhage
Sternotomy
Thrombosis
Kidney
Therapeutics
Infection
Research

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Cite this

Impact of Patient Distance From Ventricular Assist Device-Implanting Center on Short- and Long-Term Outcomes. / Ravichandran, Ashwin K.; Shah, Palak; Singh, Ramesh; Aaronson, Keith D.; Pagani, Francis D.; Stulak, John; Dunlay, Shannon M; Dardas, Todd F.; Mokadam, Nahush A.; Salerno, Christopher T.; Cowger, Jennifer A.

In: ASAIO journal (American Society for Artificial Internal Organs : 1992), Vol. 64, No. 6, 01.11.2018, p. 721-726.

Research output: Contribution to journalArticle

Ravichandran, AK, Shah, P, Singh, R, Aaronson, KD, Pagani, FD, Stulak, J, Dunlay, SM, Dardas, TF, Mokadam, NA, Salerno, CT & Cowger, JA 2018, 'Impact of Patient Distance From Ventricular Assist Device-Implanting Center on Short- and Long-Term Outcomes', ASAIO journal (American Society for Artificial Internal Organs : 1992), vol. 64, no. 6, pp. 721-726. https://doi.org/10.1097/MAT.0000000000000717
Ravichandran, Ashwin K. ; Shah, Palak ; Singh, Ramesh ; Aaronson, Keith D. ; Pagani, Francis D. ; Stulak, John ; Dunlay, Shannon M ; Dardas, Todd F. ; Mokadam, Nahush A. ; Salerno, Christopher T. ; Cowger, Jennifer A. / Impact of Patient Distance From Ventricular Assist Device-Implanting Center on Short- and Long-Term Outcomes. In: ASAIO journal (American Society for Artificial Internal Organs : 1992). 2018 ; Vol. 64, No. 6. pp. 721-726.
@article{2901ee9ba64f45ab80091ef3811ed675,
title = "Impact of Patient Distance From Ventricular Assist Device-Implanting Center on Short- and Long-Term Outcomes",
abstract = "Highly specialized left ventricular assist device care is not readily available in many areas, potentially limiting access to therapy. This retrospective analysis examines the relationship of outcomes by patient distance from implanting left ventricular assist device center within the Mechanical Circulatory Support Research Network. Zip codes were used to calculate patient distance, with the primary outcome of interest being 3-year survival by distance from the surgical center. Secondary outcomes included 90-day survival and incident event rates for the following: gastrointestinal bleeding, infection, cerebral event, and pump thrombosis. Across the four centers, there were 1184 patients supported for a median of 486 days. Overall survival was 91 ± 0.8{\%} at 90 days and 61 ± 1.9{\%} at 3 years, with worse 3-year survival in those living >90 vs. ≤90 miles from the ventricular assist device implant center (55 ± 3.0{\%} vs. 64 ± 2.5, p = 0.019). Patients living >90 miles from an implant center were older, more likely to be implanted for destination therapy support, had a prior sternotomy, and had worse renal function than those living closer (p <0.05 for all). After adjusting for these factors, albumin and center of implant, the hazard ratio did not reach statistical significance (hazard ratio = 1.2; p = 0.14). Except for gastrointestinal bleeding, the event rates for the secondary outcomes were higher for those living closer to the implanting center. Protocols should be designed for more frequent follow-up and increased shared care opportunities to ensure optimal outcomes are achieved in distant patients.",
author = "Ravichandran, {Ashwin K.} and Palak Shah and Ramesh Singh and Aaronson, {Keith D.} and Pagani, {Francis D.} and John Stulak and Dunlay, {Shannon M} and Dardas, {Todd F.} and Mokadam, {Nahush A.} and Salerno, {Christopher T.} and Cowger, {Jennifer A.}",
year = "2018",
month = "11",
day = "1",
doi = "10.1097/MAT.0000000000000717",
language = "English (US)",
volume = "64",
pages = "721--726",
journal = "ASAIO Journal",
issn = "0162-1432",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Impact of Patient Distance From Ventricular Assist Device-Implanting Center on Short- and Long-Term Outcomes

AU - Ravichandran, Ashwin K.

AU - Shah, Palak

AU - Singh, Ramesh

AU - Aaronson, Keith D.

AU - Pagani, Francis D.

AU - Stulak, John

AU - Dunlay, Shannon M

AU - Dardas, Todd F.

AU - Mokadam, Nahush A.

AU - Salerno, Christopher T.

AU - Cowger, Jennifer A.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Highly specialized left ventricular assist device care is not readily available in many areas, potentially limiting access to therapy. This retrospective analysis examines the relationship of outcomes by patient distance from implanting left ventricular assist device center within the Mechanical Circulatory Support Research Network. Zip codes were used to calculate patient distance, with the primary outcome of interest being 3-year survival by distance from the surgical center. Secondary outcomes included 90-day survival and incident event rates for the following: gastrointestinal bleeding, infection, cerebral event, and pump thrombosis. Across the four centers, there were 1184 patients supported for a median of 486 days. Overall survival was 91 ± 0.8% at 90 days and 61 ± 1.9% at 3 years, with worse 3-year survival in those living >90 vs. ≤90 miles from the ventricular assist device implant center (55 ± 3.0% vs. 64 ± 2.5, p = 0.019). Patients living >90 miles from an implant center were older, more likely to be implanted for destination therapy support, had a prior sternotomy, and had worse renal function than those living closer (p <0.05 for all). After adjusting for these factors, albumin and center of implant, the hazard ratio did not reach statistical significance (hazard ratio = 1.2; p = 0.14). Except for gastrointestinal bleeding, the event rates for the secondary outcomes were higher for those living closer to the implanting center. Protocols should be designed for more frequent follow-up and increased shared care opportunities to ensure optimal outcomes are achieved in distant patients.

AB - Highly specialized left ventricular assist device care is not readily available in many areas, potentially limiting access to therapy. This retrospective analysis examines the relationship of outcomes by patient distance from implanting left ventricular assist device center within the Mechanical Circulatory Support Research Network. Zip codes were used to calculate patient distance, with the primary outcome of interest being 3-year survival by distance from the surgical center. Secondary outcomes included 90-day survival and incident event rates for the following: gastrointestinal bleeding, infection, cerebral event, and pump thrombosis. Across the four centers, there were 1184 patients supported for a median of 486 days. Overall survival was 91 ± 0.8% at 90 days and 61 ± 1.9% at 3 years, with worse 3-year survival in those living >90 vs. ≤90 miles from the ventricular assist device implant center (55 ± 3.0% vs. 64 ± 2.5, p = 0.019). Patients living >90 miles from an implant center were older, more likely to be implanted for destination therapy support, had a prior sternotomy, and had worse renal function than those living closer (p <0.05 for all). After adjusting for these factors, albumin and center of implant, the hazard ratio did not reach statistical significance (hazard ratio = 1.2; p = 0.14). Except for gastrointestinal bleeding, the event rates for the secondary outcomes were higher for those living closer to the implanting center. Protocols should be designed for more frequent follow-up and increased shared care opportunities to ensure optimal outcomes are achieved in distant patients.

UR - http://www.scopus.com/inward/record.url?scp=85056280416&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056280416&partnerID=8YFLogxK

U2 - 10.1097/MAT.0000000000000717

DO - 10.1097/MAT.0000000000000717

M3 - Article

C2 - 29117042

AN - SCOPUS:85056280416

VL - 64

SP - 721

EP - 726

JO - ASAIO Journal

JF - ASAIO Journal

SN - 0162-1432

IS - 6

ER -