Readmissions after implantation of axial flow left ventricular assist device

Tal Hasin, Yariv Marmor, Walter K Kremers, Yan Topilsky, Cathy J. Severson, John A. Schirger, Barry A. Boilson, Alfredo L. Clavell, Richard J. Rodeheffer, Robert Frantz, Brooks Sayre Edwards, Naveen Luke Pereira, John M. Stulak, Lyle Joyce, Richard Daly, Soon J. Park, Sudhir S. Kushwaha

Research output: Contribution to journalArticle

156 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to determine the occurrence and causes of readmissions after implantation of axial flow left ventricular assist device (LVAD). Background: Based on the REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) study experience, readmissions after LVAD implantation are thought to be frequent. Methods: We retrospectively analyzed admissions to our facility in a cohort of 115 patients implanted between January 2008 and July 2011 with the HeartMate II axial flow LVAD, of whom 42 were bridged to transplant. To account for repeated events, Andersen-Gill models were used to determine possible predictors. Results: The patients were followed for 1.4 ± 0.9 years. There were 224 readmissions in 83 patients. The overall readmission rate was 1.64 ± 1.97 per patient-year of follow-up. The readmission rate for the first 6 months was 2.0 ± 2.3 and decreased to 1.2 ± 2.1 during subsequent follow-up. Leading causes were bleeding (66 readmissions in 34 patients), mostly gastrointestinal bleed (51 in 27 patients), cardiac (51 in 36 patients, most for HF or arrhythmia), infections (32 in 25 patients) of which 6 were pump related, and thrombosis (20 in 15 patients) including 13 readmissions due to hemolysis. Preoperative variables associated with (fewer) readmissions in a multivariate model include residence within our hospital-extended referral zone of Minnesota and the neighboring states (hazard ratio: 0.66; 95% confidence interval: 0.48 to 0.91; p = 0.011), hemoglobin (hazard ratio: 0.91, 95% confidence interval: 0.84 to 0.99; p = 0.027) and N-terminal pro-B-type natriuretic peptide (hazard ratio: 0.98; 95% confidence interval: 0.96 to 1.0 per 1,000-unit increase, p = 0.022). C-statistic for the model: 0.63. Conclusions: Readmission rates after axial flow LVAD implantation decrease during the first 6 months and then stabilize. The leading causes are bleeding, cardiac (heart failure and arrhythmia), infections, and thrombosis.

Original languageEnglish (US)
Pages (from-to)153-163
Number of pages11
JournalJournal of the American College of Cardiology
Volume61
Issue number2
DOIs
StatePublished - Jan 15 2013

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Heart-Assist Devices
Heart Failure
Confidence Intervals
Cardiac Arrhythmias
Thrombosis
Hemorrhage
Brain Natriuretic Peptide
Hemolysis
Infection
Hemoglobins
Referral and Consultation
Transplants

Keywords

  • complications
  • heart-assist device
  • hospital readmissions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Readmissions after implantation of axial flow left ventricular assist device. / Hasin, Tal; Marmor, Yariv; Kremers, Walter K; Topilsky, Yan; Severson, Cathy J.; Schirger, John A.; Boilson, Barry A.; Clavell, Alfredo L.; Rodeheffer, Richard J.; Frantz, Robert; Edwards, Brooks Sayre; Pereira, Naveen Luke; Stulak, John M.; Joyce, Lyle; Daly, Richard; Park, Soon J.; Kushwaha, Sudhir S.

In: Journal of the American College of Cardiology, Vol. 61, No. 2, 15.01.2013, p. 153-163.

Research output: Contribution to journalArticle

Hasin, T, Marmor, Y, Kremers, WK, Topilsky, Y, Severson, CJ, Schirger, JA, Boilson, BA, Clavell, AL, Rodeheffer, RJ, Frantz, R, Edwards, BS, Pereira, NL, Stulak, JM, Joyce, L, Daly, R, Park, SJ & Kushwaha, SS 2013, 'Readmissions after implantation of axial flow left ventricular assist device', Journal of the American College of Cardiology, vol. 61, no. 2, pp. 153-163. https://doi.org/10.1016/j.jacc.2012.09.041
Hasin, Tal ; Marmor, Yariv ; Kremers, Walter K ; Topilsky, Yan ; Severson, Cathy J. ; Schirger, John A. ; Boilson, Barry A. ; Clavell, Alfredo L. ; Rodeheffer, Richard J. ; Frantz, Robert ; Edwards, Brooks Sayre ; Pereira, Naveen Luke ; Stulak, John M. ; Joyce, Lyle ; Daly, Richard ; Park, Soon J. ; Kushwaha, Sudhir S. / Readmissions after implantation of axial flow left ventricular assist device. In: Journal of the American College of Cardiology. 2013 ; Vol. 61, No. 2. pp. 153-163.
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T1 - Readmissions after implantation of axial flow left ventricular assist device

AU - Hasin, Tal

AU - Marmor, Yariv

AU - Kremers, Walter K

AU - Topilsky, Yan

AU - Severson, Cathy J.

AU - Schirger, John A.

AU - Boilson, Barry A.

AU - Clavell, Alfredo L.

AU - Rodeheffer, Richard J.

AU - Frantz, Robert

AU - Edwards, Brooks Sayre

AU - Pereira, Naveen Luke

AU - Stulak, John M.

AU - Joyce, Lyle

AU - Daly, Richard

AU - Park, Soon J.

AU - Kushwaha, Sudhir S.

PY - 2013/1/15

Y1 - 2013/1/15

N2 - Objectives: The purpose of this study was to determine the occurrence and causes of readmissions after implantation of axial flow left ventricular assist device (LVAD). Background: Based on the REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) study experience, readmissions after LVAD implantation are thought to be frequent. Methods: We retrospectively analyzed admissions to our facility in a cohort of 115 patients implanted between January 2008 and July 2011 with the HeartMate II axial flow LVAD, of whom 42 were bridged to transplant. To account for repeated events, Andersen-Gill models were used to determine possible predictors. Results: The patients were followed for 1.4 ± 0.9 years. There were 224 readmissions in 83 patients. The overall readmission rate was 1.64 ± 1.97 per patient-year of follow-up. The readmission rate for the first 6 months was 2.0 ± 2.3 and decreased to 1.2 ± 2.1 during subsequent follow-up. Leading causes were bleeding (66 readmissions in 34 patients), mostly gastrointestinal bleed (51 in 27 patients), cardiac (51 in 36 patients, most for HF or arrhythmia), infections (32 in 25 patients) of which 6 were pump related, and thrombosis (20 in 15 patients) including 13 readmissions due to hemolysis. Preoperative variables associated with (fewer) readmissions in a multivariate model include residence within our hospital-extended referral zone of Minnesota and the neighboring states (hazard ratio: 0.66; 95% confidence interval: 0.48 to 0.91; p = 0.011), hemoglobin (hazard ratio: 0.91, 95% confidence interval: 0.84 to 0.99; p = 0.027) and N-terminal pro-B-type natriuretic peptide (hazard ratio: 0.98; 95% confidence interval: 0.96 to 1.0 per 1,000-unit increase, p = 0.022). C-statistic for the model: 0.63. Conclusions: Readmission rates after axial flow LVAD implantation decrease during the first 6 months and then stabilize. The leading causes are bleeding, cardiac (heart failure and arrhythmia), infections, and thrombosis.

AB - Objectives: The purpose of this study was to determine the occurrence and causes of readmissions after implantation of axial flow left ventricular assist device (LVAD). Background: Based on the REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) study experience, readmissions after LVAD implantation are thought to be frequent. Methods: We retrospectively analyzed admissions to our facility in a cohort of 115 patients implanted between January 2008 and July 2011 with the HeartMate II axial flow LVAD, of whom 42 were bridged to transplant. To account for repeated events, Andersen-Gill models were used to determine possible predictors. Results: The patients were followed for 1.4 ± 0.9 years. There were 224 readmissions in 83 patients. The overall readmission rate was 1.64 ± 1.97 per patient-year of follow-up. The readmission rate for the first 6 months was 2.0 ± 2.3 and decreased to 1.2 ± 2.1 during subsequent follow-up. Leading causes were bleeding (66 readmissions in 34 patients), mostly gastrointestinal bleed (51 in 27 patients), cardiac (51 in 36 patients, most for HF or arrhythmia), infections (32 in 25 patients) of which 6 were pump related, and thrombosis (20 in 15 patients) including 13 readmissions due to hemolysis. Preoperative variables associated with (fewer) readmissions in a multivariate model include residence within our hospital-extended referral zone of Minnesota and the neighboring states (hazard ratio: 0.66; 95% confidence interval: 0.48 to 0.91; p = 0.011), hemoglobin (hazard ratio: 0.91, 95% confidence interval: 0.84 to 0.99; p = 0.027) and N-terminal pro-B-type natriuretic peptide (hazard ratio: 0.98; 95% confidence interval: 0.96 to 1.0 per 1,000-unit increase, p = 0.022). C-statistic for the model: 0.63. Conclusions: Readmission rates after axial flow LVAD implantation decrease during the first 6 months and then stabilize. The leading causes are bleeding, cardiac (heart failure and arrhythmia), infections, and thrombosis.

KW - complications

KW - heart-assist device

KW - hospital readmissions

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