Readmissions after implantation of axial flow left ventricular assist device

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

doi:10.1016/j.jacc.2012.09.041

Readmissions after implantation of axial flow left ventricular assist device

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

Research output: Contribution to journal › Article › peer-review

173 Scopus citations

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 language	English (US)
Pages (from-to)	153-163
Number of pages	11
Journal	Journal of the American College of Cardiology
Volume	61
Issue number	2
DOIs	https://doi.org/10.1016/j.jacc.2012.09.041
State	Published - Jan 15 2013

Keywords

complications
heart-assist device
hospital readmissions

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jacc.2012.09.041

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Hasin, T., Marmor, Y., Kremers, W., Topilsky, Y., Severson, C. J., Schirger, J. A., Boilson, B. A., Clavell, A. L., Rodeheffer, R. J., Frantz, R. P., Edwards, B. S., Pereira, N. L., Stulak, J. M., Joyce, L., Daly, R., Park, S. J., & Kushwaha, S. S. (2013). Readmissions after implantation of axial flow left ventricular assist device. Journal of the American College of Cardiology, 61(2), 153-163. https://doi.org/10.1016/j.jacc.2012.09.041

Hasin, T, Marmor, Y, Kremers, W, Topilsky, Y, Severson, CJ, Schirger, JA, Boilson, BA, Clavell, AL, Rodeheffer, RJ, Frantz, RP , 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

@article{5a0ec6a08977449086dc7955b6a22e7c,

title = "Readmissions after implantation of axial flow left ventricular assist device",

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.",

keywords = "complications, heart-assist device, hospital readmissions",

author = "Tal Hasin and Yariv Marmor and Walter Kremers and Yan Topilsky and Severson, {Cathy J.} and Schirger, {John A.} and Boilson, {Barry A.} and Clavell, {Alfredo L.} and Rodeheffer, {Richard J.} and Frantz, {Robert P.} and Edwards, {Brooks S.} and Pereira, {Naveen L.} and Stulak, {John M.} and Lyle Joyce and Richard Daly and Park, {Soon J.} and Kushwaha, {Sudhir S.}",

note = "Funding Information: Drs. Hasin, Kushwaha, Park, and Joyce have received a research grant from Thoratec . Dr. Frantz is a consultant for Pfizer and has received research funding from United Therapeutics. Dr. Park is a consultant for Thoratec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. ",

year = "2013",

month = jan,

day = "15",

doi = "10.1016/j.jacc.2012.09.041",

language = "English (US)",

volume = "61",

pages = "153--163",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "2",

}

TY - JOUR

T1 - Readmissions after implantation of axial flow left ventricular assist device

AU - Hasin, Tal

AU - Marmor, Yariv

AU - Kremers, Walter

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 P.

AU - Edwards, Brooks S.

AU - Pereira, Naveen L.

AU - Stulak, John M.

AU - Joyce, Lyle

AU - Daly, Richard

AU - Park, Soon J.

AU - Kushwaha, Sudhir S.

N1 - Funding Information: Drs. Hasin, Kushwaha, Park, and Joyce have received a research grant from Thoratec . Dr. Frantz is a consultant for Pfizer and has received research funding from United Therapeutics. Dr. Park is a consultant for Thoratec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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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M3 - Article

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

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ER -

Readmissions after implantation of axial flow left ventricular assist device

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