Background
Widespread application of left ventricular assist devices (LVADs) in advanced heart
failure, is limited by costs, and access to technical expertise. Hospitalisation drives
both cost and inversely, quality of life − but cross institutional and pre-surgical
inpatient length of stay data is missing in the Australian literature. We describe
changes in hospitalisation rates, in the year before and after bridge to transplant
LVAD therapy and preceding heart transplant (HTX).
Methods
Hospitalisation, Australian refined diagnosis group (ArDRG), and clinical data were
assessed for 77/100 consecutive patients listed for heart transplant between July
of 2009 and June of 2012. Twenty-five of the patients required ventricular assist
device (VAD) therapy whilst waitlisted. Hospitalisation was defined as the proportion
of “days at risk” that were spent in hospital and included all public and private
admissions identified in the year before and after VAD implant, or before HTX, in
a linked administrative dataset of admissions across New South Wales.
Results
Patients requiring VADs were clinically more unstable and spent proportionally more
time in hospital than pre-HTX patients, (13% (IQR 10-20%) vs 4% (IQR1-10%), p < 0.01). During the index admission, they spent 22 days (IQR 10-33) in hospital before implantation, including 13 days in non-transplant
centres (IQR 7-20). Following implantation, median inpatient stay was 31(IQR 26-70)
– including rehabilitation in 8 of the 25 patients.
The number of admissions per patient reduced in the year after VAD-implant to two
(IQR1-3), from five pre-implant (IQR 3-7) p = 0.002. This was similar to the pre-HTX group’s three admissions (IQR1-6), p = 0.33.
Overall hospitalisation decreased in VAD patients beyond the first year − from 14%
(IQR 10-20%) at 1-year to 0.5% (IQR 0-10%) at 2-years (p = 0.002). A high percentage of hospitalisation prior to VAD (41%) and HTX (66%) occurred
outside the transplant centre.
Conclusions
A high proportion of activity in the pre-implant and transplant year occurs outside
the implanting hospital with higher pre-implant hospitalisation in VAD patients reflecting
clinical severity. Ventricular assist device implantation is significantly associated
with reduced admissions, and hospitalisation once reconditioning has occurred.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology and risk profile of heart failure.Nat Rev Cardiol. 2010; 8: 30-41
- Prevalence of heart failure in Australia: a systematic review.BMC Cardiovascular Disorders. 2016; : 1-6
- The health services burden of heart failure: an analysis using linked population health data-sets.BMC Health Services Research. 2012; 12: 103
- The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations.Int J Cardiol. 2015; 191: 256-264
- Cost-Effectiveness Analysis of Continuous-Flow Left Ventricular Assist Devices as Destination Therapy.Circ Heart Fail. 2012; 12: 10-16
- Cost-effectiveness of continuous-flow left ventricular assist devices.Int J Technol Assess Health Care. 2013; 3: 254-260
- Mechanical Circulatory Support for the Failing Heart—Progress, Pitfalls and Promises.Heart, Lung and Circulation. 2015; 24: 527-531
- Fifth INTERMACS annual report.The Journal of Heart and Lung Transplantation. 2013; 32: 141-156
- A review of ethical considerations for ventricular assist device placement in older adults.Aging Dis. 2013; 4: 100-112
- A Systematic Review of the Cost-Effectiveness of Long-Term Mechanical Circulatory Support.Value in Health. 2016; 19: 494-504
- Ethical challenges with the left ventricular assist device as a destination therapy.Philosophy, Ethics, and Humanities in Medicine. 2008; 3: 20
- The Comparative Use of Ventricular Assist Devices.Texas Heart Institute Journal. 2010; 37: 1-3
- Beyond survival: Recommendations from INTERMACS for assessing function and quality of life with mechanical circulatory support.The Journal of Heart and Lung Transplantation. 2012; 31: 1158-1164
- Implant Strategies Change Over Time and Impact Outcomes.JACC: Heart Failure. 2013; 1: 369-378
Australian Government Department of Health. The Prosthesis List [Internet]. [cited 2016 Dec 5]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/content/health-privatehealth-prostheseslist.htm.
- Days alive and out of hospital and the patient journey in patients with heart failure: Insights from the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program.Am Heart J. 2011; 162: 900-906
- Readmissions After Ventricular Assist Device: Etiologies, Patterns, and Days Out of Hospital.Ann Thorac Surg. 2013; 95: 1276-1281
- Heart Transplantation Versus Continuous-Flow Left Ventricular Assist Device: Comprehensive Cost at 1 Year.J Card Fail. 2015; 21: 160-166
- Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost Analysis.Ann Thorac Surg. 2015; 100: 884-889
- Readmissions After Implantation of Axial Flow Left Ventricular Assist Device.J Am Coll Cardiol. 2013; 61: 153-163
- Cost comparison of heart transplant vs. left ventricular assist device therapy at one year.Clin Transplant. 2016; 30: 598-605
- Institutional Cost Comparison Between Heart Transplants and Left Ventricular Assist Device Implantations.Experimental and Clinical Transplantation. 2016; 14: 656-659
Centre for Health Record Linkage. [Internet]. [cited 2016 Dec 5]. Available from: http://www.cherel.org.au/. Accessed 21st July 2017.
- INTERMACS Profiles of Advanced Heart Failure: The Current Picture.J Heart Lung Transplant. 2009; 28: 535-541
- Patient selection for left ventricular assist devices.Eur J Heart Fail. 2010; 12: 434-443
- Cost of ventricular assist devices-can we afford the progress.Circulation. 2013; 127: 743-748
- Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: Design and rationale of the ROADMAP clinical trial.American Heart Journal. 2015; 169: 205-220
- Right ventricular failure after left ventricular assist devices.J Heart Lung Transplant. 2015; 34: 1123-1130
- Ventricular Assist Device Implantation in the Elderly: Nationwide Outcomes in the United States.J Cardiac Surgery. 2013; 28: 183-189
- Patient Selection for Left Ventricular Assist Devices.Congestive Heart Failure. 2011; 17: 227-234
- Right heart failure and “failure to thrive” after left ventricular assist device: Clinical predictors and outcomes.The Journal of Heart and Lung Transplantation. 2011; 30: 888-895
- Predictive value of the Seattle Heart Failure Model in patients undergoing left ventricular assist device placement.J Heart Lung Transplant. 2010; 29: 1021-1025
- Accuracy and completeness of patient pathways – the benefits of national datalinkage in Australia.BMC Health Services Research. 2015; 15: 312
Article info
Publication history
Published online: July 18, 2017
Accepted:
June 2,
2017
Received in revised form:
May 15,
2017
Received:
March 22,
2017
Identification
Copyright
© 2017 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
