Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in Gastrointestinal Bleeding

Li, Feng; Hinton, Alice; Chen, Alan; Mehta, Nishaki; El-Dika, Samer; Zhang, Cheng; Hussan, Hisham; Conwell, Darwin L.; Krishna, Somashekar G.

doi:10.1007/s10620-016-4379-8

Cited by 13 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because of the high frequency of bleeding and bleeding vascular malformations, one might consider using earlier VCE during bleeding events ( 29 , 30 ). In patients presenting with supratherapeutic INRs more than 3, capsule endoscopy on admission may be especially useful in gathering more data to guide decision making on the type of endoscopic evaluation to pursue while waiting for INR to drift down to a safe range for endoscopy.…”

Section: Discussionmentioning

confidence: 99%

A multi-center study of left ventricular assist device (LVAD)-related gastrointestinal bleeding

Dailey

Nguyen

Kohli

et al. 2022

Clin Transl Gastroenterol

View full text Add to dashboard Cite

INTRODUCTION: Continuous left ventricular assist devices (LVADs) offer hemodynamic support in advanced and decompensated heart failure but are often complicated by gastrointestinal bleeding (GIB) in medically fragile patients. METHODS: We performed a retrospective analysis of 475 consecutive patients who underwent LVAD implantation at the Massachusetts General Hospital and Tufts Medical Center from 2008 to 2019 and identified 128 patients with clinically significant GIB. Clinical characteristics of each bleeding event, including procedures and interventions, were recorded. We examined LVAD patients with overt and occult presentations to determine diagnostic endoscopic yield and analyzed predictors of recurrent GIB. RESULTS: We identified 128 unique patients with LVAD implantation complicated by GIB. No significant difference was observed based on study center, underlying cardiomyopathy, race/ethnicity, serum indices, and medications used. Overt bleeders presented more commonly during LVAD implantation admission ( P = 0.001) than occult bleeders. Occult bleed presentations had only 1 lower and no middle GI bleed source identified, despite similar workups to overt bleeds. Destination therapy (e.g., among nontransplant candidates) LVAD implantation (odds ratio 2.38, 95% confidence interval 1.05–5.58) and a history of GIB (odds ratio 3.85, 95% confidence interval 1.29–12.7) were independently associated with an increased risk of recurrent GIB-related hospitalization. DISCUSSION: Our findings confirm a high rate of GIB, especially in destination LVAD patients, and show a low diagnostic yield for colonoscopy and middle GI bleed assessments in LVAD patients with occult bleeds. Overt bleeding was more common and associated with vascular malformations. Although endoscopic interventions stopped active hemorrhage, GIB often recurred.

show abstract

Section: Discussionmentioning

confidence: 99%

A multi-center study of left ventricular assist device (LVAD)-related gastrointestinal bleeding

Dailey

Nguyen

Kohli

et al. 2022

Clin Transl Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Our analysis encompasses the nationwide sample of CF-LVADs since their approval in 2008. ICD codes for GI bleeding used in the analysis are highly specific and have been previously validated to have high accuracy [ 31 ]. Our analysis is, however, limited by its retrospective design.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends and risk factors of gastrointestinal bleeding in patients with left ventricular assist devices: a nationwide analysis 2008-2017

Vohra¹

2023

aog

View full text Add to dashboard Cite

Background Left ventricular assist devices (LVADs) are indicated for patients with end-stage heart failure and require systemic anticoagulation. Gastrointestinal (GI) bleeding is a major adverse event following LVAD implantation. There is paucity of data on healthcare resource utilization in patients with LVAD and the risk factors of associated bleeding, despite the increase in GI bleeding. We investigated the in-hospital outcomes of GI bleeding in patients with continuous-flow (CF) LVAD. Methods This was a serial cross-sectional study of the Nationwide Inpatient Sample (NIS) in the CF-LVAD era from 2008-2017. All adults admitted to hospital with a primary diagnosis of GI bleeding were included. GI bleeding was diagnosed by ICD-9/ICD-10 codes. Patients with CF-LVAD (cases) and without CF-LVAD (controls) were compared using univariate and multivariate analyses. Results A total of 3,107,471 patients were discharged with a primary diagnosis of GI bleeding during the study period. Of these, 6569 (0.21%) had CF-LVAD-related GI bleeding. Overall, bleeding angiodysplasia accounted for the majority (69%) of LVAD-related GI bleeding. There was no statistical difference in mortality, but the length of hospital stay increased by 2.53 days (95% confidence interval [CI] 1.78-2.98; P<0.001) and the mean hospital charge per stay increased by $25,980 (95%CI 21,267-29,874; P<0.001) in 2017 compared to 2008. The results were consistent after propensity score matching. Conclusion Our study highlights that patients with LVAD admitted to the hospital for GI bleeding experience longer hospital stays and greater healthcare costs that warrant risk-based patient evaluation and careful implementation of management strategies.

show abstract

“…The clinical relevance of our study can boil down to two significant takeaways: patient morbidity and healthcare associated cost. A recently published study looking at cost and mortality showed that patients with continuous-flow LVADs related GIBs were found to have longer hospitalizations and higher hospital charges without a significant association with mortality [ 15 ]. This translates into more money being spent without any major benefit.…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors for Repeat Hospitalizations in Left Ventricular Assist Device (LVAD) Patients With Gastrointestinal Bleeding

et al. 2018

View full text Add to dashboard Cite

BackgroundPatients implanted with left ventricular assist devices (LVAD) carry an increased risk of gastrointestinal bleeding (GIB), estimated at 25% in most studies. Significant efforts are employed in localizing and stopping the source of bleeding, but the rates of repeat hospitalization for GIB remain surprisingly high. Given the increasing incidence of LVAD-dependent end-stage heart failure and the excessive costs associated with repetitive endoscopic investigations, risk factors associated with re-bleeding need to be determined. The aim of our study was to investigate clinical predictors associated with repeat hospitalizations for GIB in patients implanted with a LVAD.MethodsWe conducted a retrospective cohort using the prospectively assembled ventricular assist device database at the University of Alabama at Birmingham. We identified all end-stage heart failure patients who were implanted with a continuous-flow (CF) LVAD between Jan 1, 2009 and Dec 31, 2013. We excluded pulsatile devices, biventricular assist devices (BiVADs), right ventricular assist devices (RVADs), and patients under 19 years of age.ResultsThere were 102 patients implanted with a CF-LVAD within the specified time period. With an average follow-up of 127 weeks, 32 (31.4%) patients developed GIB requiring 79 separate hospitalizations. Average time from LVAD implantation to first bleed was 343 days. The re-bleeding rate requiring readmission was 56.3% in those admitted with GIB, with eight (25%) of the patients necessitating multiple readmissions. The average hospital stay for a primary diagnosis of GIB was 9.45 days. Totally, 68 (86%) patients required endoscopic evaluation during their hospitalization, with 35 (44%) necessitating multiple procedures during the same admission. The average time to first endoscopy was 2.5 days with a median of 2 days. Patients receiving early endoscopy (< 48 h from admission) were 57% less likely to require future readmission for GIB compared to patients undergoing late endoscopy (> 48 h) (OR: 0.43, CI: 0.19 - 0.9). Other factors associated with repeat admissions for GIB included indication for LVAD (bridge to transplant had OR: 0.07, CI: 0.02 - 0.27), male gender (OR: 10.4, CI: 1.8 - 59), length of initial hospital stay (OR: 0.83, CI: 0.71 - 0.97), and INR on admission (OR: 3.6, CI: 1.46 - 8.8). Although not statistically significant, patients undergoing subsequent endoscopies during a single admission were 84% less likely to develop re-bleeding in the future (OR: 0.158, CI: 0.025 - 1.02).ConclusionsGIB in LVAD patients is a significant problem with high rates of readmission despite extensive endoscopic investigations and anticoagulant adjustments. Our experience revealed that early endoscopy, longer initial hospital stay, and better INR control were all associated with decreased rates of readmission for GIB in this population. These modifiable factors should be emphasized and addressed in the future to reduce the burdens associated with repeated hospitalizations.

show abstract

Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in Gastrointestinal Bleeding

Cited by 13 publications

References 24 publications

A multi-center study of left ventricular assist device (LVAD)-related gastrointestinal bleeding

A multi-center study of left ventricular assist device (LVAD)-related gastrointestinal bleeding

Temporal trends and risk factors of gastrointestinal bleeding in patients with left ventricular assist devices: a nationwide analysis 2008-2017

Clinical Predictors for Repeat Hospitalizations in Left Ventricular Assist Device (LVAD) Patients With Gastrointestinal Bleeding

Contact Info

Product

Resources

About