Trends in left ventricular assist device use and outcomes among Medicare beneficiaries, 2004–2011

Abstract

ObjectiveTo characterise the trends in the left ventricular assist device (LVAD) implantation rates and outcomes between 2004 and 2011 in the Medicare population. Since the approval of the HeartMate II in 2008, the use of LVADs has steadily climbed. Given the increase in LVAD use, issues around discharge disposition, post-implant hospitalisations and costs require further understanding.MethodsWe examined LVAD implantation rates and short-term and long-term outcomes among Medicare fee-for-service beneficiaries hospitalised for LVAD implantation. We also conducted analyses among survivors 1-year post-discharge to examine rehospitalisation rates. Lastly, we reported Centers for Medicare & Medicaid Services (CMS) payments for both index hospitalisation and rehospitalisations 1 year post-discharge.ResultsA total of 2152 LVAD implantations were performed with numbers increasing from 107 in 2004 to 612 in 2011. The 30-day mortality rate decreased from 52% to 9%, and 1-year mortality rate decreased from 69% to 31%. We observed no change in overall length of stay, but post-procedure length of stay increased. We also found an increase in home discharge dispositions from 26% to 53%. Between 2004 and 2010, the rehospitalisation rate increased and the number of hospital days decreased. The adjusted CMS payment for the index hospitalisation increased from $188 789 to $225 697 over time but decreased for rehospitalisation from $60 647 to $53 630.ConclusionsLVAD implantations increased over time. We found decreasing 30-day and 1-year mortality rates and increasing home discharge disposition. The proportion of patients rehospitalised among 1-year survivors remained high with increasing index hospitalisation cost, but decreasing post-implantation costs over time.

Outcomes Associated With Left Ventricular Assist Devices Among Recipients With and Without End-stage Renal Disease

“…2,3,5,7 The REMATCH trial reported a 1-year survival of 52% among LVAD recipients. 1 Among Medicare free-for-service beneficiaries hospitalized for LVAD placement, 30-day mortality was 9% and 1-year mortality was 31% in 2011, representing a substantial decrease since 2004.…”

“…1 In 2008–fueled by advances in LVAD technology, scarcity of donor hearts, 1 and a growing number of patients who are ineligible heart transplantation due to comorbidity 4 –the US Food and Drug Administration approved the use of LVADs as destination therapy for advanced heart failure, paving the way for expansion in the use of these devices. 5–7 …”

Stroke Risk and Mortality in Patients With Ventricular Assist Devices

“…The vast majority (95%) of VADs placed in the United States are durable continuous flow left ventricular assist devices, and this code has been used to study the epidemiology of these devices. 2, 13 Patients were included regardless of whether they underwent VAD placement as destination therapy or as a bridge to transplantation. We excluded patients with a documented stroke prior to the index visit for VAD placement.…”

Women and heart disease, the underrecognized burden: sex differences, biases, and unmet clinical and research challenges

“…Nevertheless, women appear to be referred for LVAD later in their clinical course with more severe heart failure [68,69]. The rates of implant in women are significantly lower than in men; one study of Medicare beneficiaries who underwent LVAD implant between 2004 and 2011 showed only 17 % of those receiving LVADs were women [70].…”