Left ventricular assist systems and infection-related outcomes: A comprehensive analysis of the MOMENTUM 3 trial

Patel, Chetan B.; Blue, Laura; Cagliostro, B.; Bailey, Stephen; Entwistle, John W.; John, Ranjit; Thohan, Vinay; Cleveland, Joseph C.; Goldstein, Daniel J.; Uriel, Nir; Su, Xiaolu; Somo, Sami I.; Sood, Poornima; Mehra, Mandeep R.

doi:10.1016/j.healun.2020.03.002

Cited by 61 publications

(57 citation statements)

References 21 publications

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“…Although these data reflect experiences through July 2017, this cohort represents to our knowledge the largest, most contemporaneous VAD experience evaluating HAIs among Medicare beneficiaries. Comparable survival at 90-days and major HAI rates between this report and The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With Heart-Mate 3 (MOMENTUM 3) experience 8 support the generalizability of our findings.…”

Section: Discussionsupporting

confidence: 73%

“…Importantly, HAI rates reported in this study are very similar to other published HAI rates documented from recent randomized clinical trials of durable VADs. [5][6][7][8] Third, pre-and postprocedure inpatient payment estimates assume a constant daily payment rate that might not be reflective of all patients' experiences; nonetheless, price standardization methods account for differences attributed to local and regional practice differences. Fourth, unmeasured confounding might persist.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although HAI rates have decreased over time, 3,4 in part because of technological advancements, patients receiving VAD support continue to have substantial 90-day risk of HAIs (12.7 HAIs per 100 patient-months [device-related] and 38.5 HAIs per 100 patient-months [nondevice-related]). [5][6][7][8] Although previous work has informed an understanding of risk factors associated with HAIs after VAD implantation, 9,10 less is known about interhospital variability in HAI risk and its effect on spending beyond the initial implantation admission. Addressing these knowledge gaps would provide: (1) clinical and financial benchmarks for hospitals wishing to assess their HAI performance, and (2) targets for local quality improvement to reduce HAIs.…”

Section: See Commentary On Page XXXmentioning

confidence: 99%

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Interhospital variability in health care–associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries

Yang

Malani

Fetters

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Objective: The objective of this study was to investigate variations across hospitals in infection rates and associated costs, the latter reflected in 90-day Medicare payments. Despite high rates and expenditures of health care-associated infections associated with durable ventricular assist device implantation, few studies have examined interhospital variation and associated costs.Methods: Clinical data on 8688 patients who received primary durable ventricular assist devices from July 2008 to July 2017 from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n ¼ 120) were merged with postimplantation 90-day Medicare claims. Terciles of hospital-specific, risk-adjusted infection rates per 100 patient-months were estimated using Intermacs and associated with Medicare payments (among 5440 Medicare beneficiaries). Primary outcomes included infections within 90 days of implantation and Medicare payments.Results: There were 3982 infections identified among 27.8% (2417/8688) of patients developing an infection. The median (25th, 75th percentile) adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 (9.3, 19.5) and varied according to hospital (range, 0.0-35.6). Total Medicare payments from implantation to 90 days were 9.0% (absolute difference: $13,652) greater in high versus low infection tercile hospitals (P<.0001). The period between implantation to discharge accounted for 73.1% of the difference in payments during the implantation to 90-day period across terciles.Conclusions: Health care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures. Interventions targeting preventing infections could improve the value of durable ventricular assist device support from the societal and hospital perspectives.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: See Commentary On Page XXXmentioning

confidence: 99%

See 1 more Smart Citation

Interhospital variability in health care–associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries

Yang

Malani

Fetters

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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“…22 A comprehensive analysis of the MOMENTUM 3 study pointed that female gender, usage of pre-implant intraaortic balloon pump, personal history of cardiac surgery, and obesity are independent risk factors for major infectious complications in the first 2 years post-intervention. 23 A…”

Section: Infectionsmentioning

confidence: 99%

Left Ventricular Assist Device-Related Complications

Clément¹,

Anghel

Sascău

et al. 2020

Journal of Cardiovascular Emergencies

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Left ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.

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“…Nevertheless, adverse events such as renal failure, right heart failure, device malfunction, and infection account for a significant morbidity and mortality burden for LVAD populations. 1,2 Likosky and colleagues 3 present their work on durable LVAD health care-associated infection and its influence on Medicare costs as well as other adverse events.…”

mentioning

confidence: 99%