Readmissions after continuous flow left ventricular assist device implantation

Abstract

Continuous flow left ventricular assist device (CF-LVAD) therapy has improved the survival of patients with advanced heart failure. However, the readmission rate of CF-LVAD patients is still relatively high. A total of 90 patients who received CF-LVADs between April 2011 and March 2016 at our institute and were discharged home were analyzed retrospectively. They were followed up through March 2017. Clinical data, including frequency, length and etiology of readmission, were obtained from medical records. The mean observation period after initial discharge was 713 ± 322 days. In total, 73 patients (81%) had 236 readmissions, 214 unplanned and 22 planned. The overall and unplanned readmission rates were 1.34 and 1.22 per patient-year, respectively. The rate of freedom from unplanned first readmission at 1 year after initial discharge was 39%. The median interval between the previous hospital discharge and first and second readmissions was 311 and 213 days, respectively (log-rank test, p = 0.117). The rate of readmission after more than three readmissions was significantly higher than that of first or second readmission (log-rank test, p < 0.001). The most common etiology of readmission was driveline infection (DLI) (36%), followed by stroke (9%). The median length of hospital stay due to DLI was 23 days. The patients with repeated unplanned readmissions had significantly lower EuroQol 5 dimensions questionnaire utility score than those with no or just one readmission. Readmission was common in CF-LVAD patients, and the most common etiology of readmissions was DLI. The interval to the next readmission seemed shorter for patients with repeated readmissions.

Clinical outcomes of inpatient cardiac rehabilitation for patients with treated left ventricular assist device in Korea: 1-year follow-up

“…The readmission frequency of 3.2 per patient-year in this study was slightly higher than that reported in previous studies. The mean time to first readmission was 57 days, which was longer than a previous report (Vidula et al, 2018) of 48 days but shorter than in a report by Kimura et al (2017). The readmission frequency differed between implanted HeartMate-II or HeartWare devise (Haglund et al, 2015) but was not different between destination therapy and bridge to transplantation LVAD recipients (Bradner et al, 2013).…”

“…Readmission rate or frequency is an important clinical outcome, and several studies (Kimura et al, 2017; Vidula et al, 2018) have reported the average readmission frequency range of 1.34–1.79 per patient-year after discharge. The readmission frequency of 3.2 per patient-year in this study was slightly higher than that reported in previous studies.…”

The analysis of unplanned readmissions after left ventricular assist device implantation as bridge-to-transplant

“…The rate of unplanned readmission was 1.7 per year in our cohort, consistent with the previously published data. [4,15,16] In addition, the frequency of readmissions reduced monotonically during follow-up, which indicates that LVAD therapy is associated with further recovery in overall medical profile of patients over time in this population.…”

“…[3] Previous reports have revealed that readmission rate is around 80% during follow-up, and most of them are unplanned. [4,5] Due to the rapid increase and diversification of this specific patient population, it is important to analyze the problems encountered in the outpatient setting.…”

The Rehabilitation of Patients With Advanced Heart Failure After Left Ventricular Assist Device Placement: A Narrative Review

“…Multiple risk factors for stroke occurrence after LVAD implantation have been documented, including history of stroke, pre‐existing atrial fibrillation, diabetes mellitus, suboptimal anticoagulation regimens, hypertension, systemic infection, and aortic cross‐clamping with cardioplegic arrest . Regardless of etiology, postoperative stroke is an important cause of morbidity after LVAD implantation and can be a cause for hospital readmissions .…”