Optimal Hemodynamics During Left Ventricular Assist Device Support Are Associated With Reduced Readmission Rates

Abstract

BACKGROUND: Left ventricular assist device (LVAD) therapy improves the hemodynamics of advanced heart failure patients. However, it is unknown whether hemodynamic optimization improves clinical outcomes. The aim of this study was to investigate whether hemodynamic optimization reduces hospital readmission rate in LVAD patients. METHODS AND RESULTS: LVAD patients undergoing an invasive hemodynamic ramp test were prospectively enrolled and followed for 1 year. LVAD speed was optimized using a ramp test, targeting the following goals: central venous pressure <12 mm Hg, pulmonary capillary wedge pressure <18 mm Hg, and cardiac index >2.2 L/(min•m 2). The frequency and cause of hospital readmissions were compared between patients who achieved (optimized group) or did not achieve (nonoptimized group) these goals. Eighty-eight outpatients (median 61 years old, 53 male) underwent ramp testing 236 days after LVAD implantation, and 54 (61%) had optimized hemodynamics after LVAD speed adjustment. One-year survival after the ramp study was comparable in both groups (89% versus 88%). The total hospital readmission rate was lower in the optimized group compared with the nonoptimized group (1.15 versus 2.86 events/y, P<0.001). This result was predominantly because of a reduction in the heart failure readmission rate in the optimized group (0.08 versus 0.71 events/y, P=0.016). CONCLUSIONS: LVAD patients, in whom hemodynamics were optimized, had a significantly lower rate of hospital readmissions, primarily because of fewer heart failure admissions. These findings highlight the importance of achieving hemodynamic optimization in LVAD patients.

Ventricular arrhythmias following continuous‐flow left ventricular assist device implantation: A systematic review

“…However, 2.86 events/year; P < .001), which was largely attributed to the significant reduction in heart failure readmissions (0.08 vs. 0.71 events/year; P = 0.016). 21 Further research is required to determine the effects of such hemodynamic optimization on the incidence, severity, and outcomes of VA in CF-LVAD patients. Additionally, this highlights the need for enhanced pump monitoring in patients with CF-LVADs.…”

Hemodynamics of concomitant tricuspid valve procedures at LVAD implantation

“…Clinically stable LVAD outpatients received ramp test, but there may be selection bias. The timing of ramp test varied, which may affect the clinical outcome, although we previously demonstrated that the timing of ramp test did not affect clinical outcomes . We do not have TR data during ramp test, whether TVR prevent worsening of TR at incremental LVAD speed remains unknown.…”

Implication of Hemodynamic Assessment during Durable Left Ventricular Assist Device Support

“…Particularly, many LVAD patients seem to have inappropriately elevated central venous pressure indicative of sub-clinical right heart failure [13,14]. LVADs are designed to reduce the right ventricular afterload by reducing pulmonary artery pressures, whereas the preload experienced by the right ventricle increases due to the improved systemic circulation.…”