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. 2014 Aug 5;1(1):e000109.
doi: 10.1136/openhrt-2014-000109. eCollection 2014.

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

Julianna F Lampropulos  1 , Nancy Kim  2 , Yun Wang  3 , Mayur M Desai  4 , José Augusto S Barreto-Filho  5 , John A Dodson  6 , Daniel L Dries  7 , Abeel A Mangi  8 , Harlan M Krumholz  9
Affiliations

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

Julianna F Lampropulos et al. Open Heart. .

Abstract

Objective: To 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.

Methods: We 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.

Results: A 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.

Conclusions: LVAD 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.

Keywords: HEART FAILURE.

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Figures

Figure 1
Figure 1
Trends in LVAD implantation rates among the Medicare population from 2004 to 2011. Rates of LVAD implantation were calculated as numbers of LVAD procedures per 1 million person-years. Grey area: 95% confidence limits; diamond: observed values; solid line: growth trend over time; p=0.0395. LVAD, left ventricular assist device.
Figure 2
Figure 2
(A) Observed relative and risk-adjusted annual changes for mortality rates and 30-day readmission rates comparing 2011 with 2004. (B) Point estimates with respect to changes of hospitalisation rates, 30-day, and 1-year mortality, comparing 2004 to 2011.
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References

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