Use of Post-acute Care Services and Readmissions After Left Ventricular Assist Device Implantation in Privately Insured Patients

Abstract

Background Very little is known about healthcare resource utilization, including post-acute care use and hospital readmissions, following left ventricular assist device (LVAD) implantation. Methods and Results Administrative claims from a database of multiple U.S. health plans were used to identify patients that received an LVAD (ICD-9 code 37.66) and survived to hospital discharge from January 1, 2006 through September 30, 2013. Post-acute care use was defined as a skilled nursing facility or rehabilitation stay within 90 days after hospital discharge. Patients were censored at heart transplantation or end of coverage through December 31, 2013. Of 583 patients (mean age 55 years, 77% male), 223 (38.3%) utilized post-acute care services, which was more common in patients with diabetes, those who required hemodialysis, those who had LVADs implanted at hospitals in more populated areas, with more beds and in the Northeast region (p<0.05 for each). The most common reasons for readmission were device complications, heart failure, and arrhythmia. Readmission risk was higher in patients who had diabetes, peripheral vascular disease and longer hospital length of stay, but did not differ by post-acute care use. Conclusions Use of post-acute care services varies based on hospital characteristics. We found no association between post-acute care use and readmission risk after LVAD.

Readmission and resource utilization after orthotopic heart transplant versus ventricular assist device in the National Readmissions Database, 2010–2014

“…10,12 Bed size, teaching, and geographic location (urban versus rural) were included to adjust for hospital variability in OHT and VAD performance. 5,13 Hierarchic regression adjusting for hospital covariance in the nested sampling design was utilized as recommended for the NRD database. Mortality, duration of stay, and log-transformed costs were modeled using logistic, Poisson, and linear distributions, respectively.…”

Psychosocial characteristics and outcomes in patients with left ventricular assist device implanted as destination therapy

“…Finally, readmissions at other institutions were not captured in this study. However, recent data suggests that 86% of readmissions after LVAD are to the implanting hospital 22 . In addition to the limitations, there are several notable strengths.…”

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

“…We conducted a retrospective analysis of administrative claims data from a large US commercial insurance database, Optum Labs Data Warehouse, which is comprised of privately insured enrollees from geographically diverse regions across the country. 10,11 The database includes professional, facility, and outpatient medication service claims for individuals enrolled in private and Medicare Advantage health plans. 12 Because this study involved analysis of preexisting, de-identified data, it was exempt from institutional review board approval.…”