Trends, etiologies, and predictors of 90‐day readmission after percutaneous ventricular assist device implantation: A national population‐based cohort study

Abstract

Percutaneous ventricular assist devices (pVADs) are indicated to provide hemodynamic support in high-risk percutaneous interventions and cardiogenic shock. However, there is a paucity of published data regarding the etiologies and predictors of 90-day readmissions following pVAD use. We studied the data from the US Nationwide Readmissions Database (NRD) for the years 2013 and 2014. Patients with a primary discharge diagnosis of pVAD use were collected by searching the database for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedural code 37.68 (Impella and TandemHeart devices). Amongst this group, we examined 90-day readmission rates. Comorbidities as identified by "CM_" variables provided by the NRD were also extracted. The Charlson Comorbidity Index was calculated using appropriate ICD-9-CM codes, as a secondary diagnosis. A 2-level hierarchical logistic regression model was then used to identify predictors of 90-day readmission following pVAD use. Records from 7074 patients requiring pVAD support during hospitalization showed that 1562 (22%) patients were readmitted within 90 days. Acute decompensated heart failure (22.6%) and acute coronary syndromes (11.2%) were the most common etiologies and heart failure (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.17-1.67), chronic obstructive pulmonary disease (OR: 1.26, 95% CI: 1.07-1.49), peripheral vascular disease (OR: 1.305, 95% CI: 1.09-1.56), and discharge into short- or long-term facility (OR: 1.28, 95% CI: 1.08-1.51) were independently associated with an increased risk of 90-day readmission following pVAD use. This study identifies important etiologies and predictors of short-term readmission in this high-risk patient group that can be used for risk stratification, optimizing discharge, and healthcare transition decisions.

Causes and predictors of 30-day readmissions in patients with cardiogenic shock requiring extracorporeal membrane oxygenation support

“…Although CS represents a small percentage of all heart failure patients, the mortality rate can be well over 50% and the cost to treat these patients is often exorbitantly high, with readmission rates well above the all-cause rates for both Medicare and commercial populations. [13][14][15] One of the principal methods for restoring hemodynamic stability in CS patients is via mechanical hemodynamic support, which was traditionally achieved with IABP, percutaneous LVAD, or if necessary, ECMO. 16,17 There has been a substantial increase in the use of ECMO for management of refractory CS in the past decade.…”

“…11,19 Among the cardiovascular reasons, heart failure was the leading cause of readmissions followed by arrhythmia and hypertension; similar findings were found in comparable studies. 11,15,19 Given that these patients undergo invasive procedures and LVAD implantation/ heart transplantation, the second major cause of readmission was complications of medical care/surgical procedures (including but not limited to LVAD infection, transplant rejection, surgical site infection, etc.). These areas represent a potential for improvement by establishing closer follow-up after discharge and enhancing care during admission.…”

In Reference to Trends, Etiologies, and Predictors of 90‐Day Readmission After Percutaneous Ventricular Assist Device Implantation: A National Population‐Based Cohort Study

“…A particular concern about Virk et al's study is that analysis was confined to an administrative dataset (as provided by National Readmission Database from 2013 to 2014) that lacked key clinical, angiographic, and procedural details . As TandemHeart and Impella implantation fall under the same International Classification of Diseases, Ninth Revision code for pVAD, it was not possible in this study to determine which patients received which particular type of pVAD.…”

“…We read with interest Virk et al's recent informative study regarding trends, etiologies, and predictors of 90-day readmission after percutaneous ventricular assist device (pVAD) implantation. 1 We have a number of comments and concerns regarding this article.…”