Highlights
- •Among LVAD recipients who survived to discharge from index admission, 28.1% had 30-day readmission.
- •Most of the readmissions occurred in the first 15 days after discharge from the index admission.
- •The most frequent cause of readmissions was gastrointestinal bleeding, followed by heart failure.
- •Intracranial bleeding, device thrombosis, and ischemic stroke had the highest mortality.
- •Readmission rates for gastrointestinal bleeding decreased, whereas device infection increased.
Abstract
Background
Left ventricular assist devices (LVAD) improve morbidity and mortality in end-stage
heart failure patients, but high rates of readmissions remain a problem after implantation.
We aimed to assess the incidence, trends, outcomes, and predictors of device-related
30-day readmissions after LVAD implantation.
Methods
The National Readmission Database was used to identify patients who underwent LVAD
implantation between 2012 and 2017 and those with 30-day readmissions.
Results
The analysis included a total of 16499 adults who survived the index hospitalization
for LVAD implantation. Among those, 28.1% were readmitted at 30 days, and the readmission
rate has been grossly stable during the study period. Most of the readmissions occurred
in the first 15 days after discharge from the index admission. The most frequent cause
of readmissions was gastrointestinal bleeding (14.9% of readmissions), followed by
heart failure, arrhythmias, device infection, and device thrombosis. Among reasons
for readmission, intracranial bleeding was associated with highest mortality (37.6%),
followed by device thrombosis (13.1%), and ischemic stroke (7.6%). Intracranial bleeding
and device thrombosis were associated with lengthier stay (20.4 and 15.5 days, respectively).
Readmission rates for gastrointestinal bleeding decreased, whereas device infection
increased. Multivariate logistic regression model revealed the length of stay, oxygen
dependence, gastrointestinal bleeding at index admission, depression and ECMO, private
insurance as independent predictors of 30-day readmission.
Conclusion
Over one-fourth of LVAD recipients have 30-day readmissions, with most of them occurring
within 15 days. Most frequent cause of readmission was gastrointestinal bleeding,
which was associated with the lowest in-hospital mortality among other complications.
Keywords
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Article info
Publication history
Published online: October 07, 2020
Accepted:
October 5,
2020
Received in revised form:
September 30,
2020
Received:
August 13,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
