Hospitalization Prior to Index Admission for Ventricular Assist Device Implantation Decrease Mortality and Cost
Brandon S. Hendriksen, Eric W. Schaefer, Christopher S. Hollenbeak, John V. Conte, Behzad Soleimani, Penn State Medical Center, Hershey, PA, USA
OBJECTIVE: Implantation of ventricular assist devices (VADs) for patients with advanced heart failure is increasing in prevalence. VADs are used as bridges to transplantation, support from reversible cardiomyopathy, or as destination therapy. Optimal timing and medical preparation necessary for placement of VADs has not been fully elucidated. We hypothesized that earlier VAD implantation, indicated by fewer hospitalizations in the 6-months prior to surgery, would decrease mortality and costs.
METHODS: The Truven MarketScan database identified VAD placements from 2005-2014. Patients whose index admission included extra-corporeal membrane oxygenation (ECMO) treatment were analyzed separately. Mortality and costs were analyzed according to the number of hospitalizations 6-months prior to VAD implantation with multivariate modeling. Bootstrapping provided confidence intervals for costs.
RESULTS: The data contained 1,390 VAD implantations; 3% (46/1,390) required ECMO during the index surgical admission. 71% (953/1,344) of the non-ECMO group had hospitalizations 6-months prior to surgical admission while only 39% (18/46) of ECMO patients had prior hospitalization. Mortality rates were 14% (non-ECMO) and 52% (ECMO). Hospitalizations prior to VAD placement were associated with decreased mortality in the non-ECMO group (p<0.001) but not significant in the ECMO group (p=0.393). Mean costs of surgical admission decreased from ,000 to ,000 for 0 to ‰¥3 prior hospitalizations (p<0.001) in the non-ECMO group. Differences in cost were not statistically significant in the ECMO group.
CONCLUSIONS: Hospitalizations prior to VAD implantation were associated with decreased mortality and cost until patients required ECMO. Medical optimization prior to VAD implantation plays an important role in outcomes but delays may cause significant increases in mortality.