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Observational Study
. 2025 Aug 1;71(8):628-636.
doi: 10.1097/MAT.0000000000002382. Epub 2025 Mar 3.

Survival and Readmission Burden in Advanced Heart Failure Patients Managed With Ventricular Assist Device Versus Continued Medical Therapy

Jeffrey D Alexis  1 , Katherine Wood  1 , Igor Gosev  1 , Anas Jawaid  1 , Leway Chen  1 , Anuradha Godishala  1 , Mark Tallman  1 , Sabu Thomas  1 , John Martens  1 , Bronislava Polonsky  1 , Anita Y Chen  2 , Scott McNitt  1 , Saadia Sherazi  1 , Ilan Goldenberg  1
Affiliations
Observational Study

Survival and Readmission Burden in Advanced Heart Failure Patients Managed With Ventricular Assist Device Versus Continued Medical Therapy

Jeffrey D Alexis et al. ASAIO J. .

Abstract

As questions remain about the risk-benefit of left ventricular assist device (LVAD) therapy, we evaluated the association between LVAD versus medical therapy for the competing risk of all-cause mortality and all-cause readmission. Among consecutive patients evaluated for advanced heart failure (HF) therapy, 260 were referred for LVAD implantation and 292 continued medical therapy in this retrospective, observational database study. At 2 years, all-cause mortality was significantly higher among medically managed patients versus LVAD recipients (37% vs. 25%, p = 0.014). Separation in event rates appeared within 3 months and was sustained throughout follow-up. The cumulative incidence rate of all-cause readmissions at 2 years was higher among LVAD recipients (78% vs. 40%, p < 0.001). In multivariate analysis, compared with medical therapy, LVAD therapy was associated with a significant 35% lower risk of death ( p = 0.005), driven by a 57% reduction in the risk of death within the first 3 months ( p < 0.001), and a 2.8-fold increased risk of readmission. Among medically managed patients, lower baseline hemoglobin and blood pressure, older age, and increased creatinine were predictors of death. In conclusion, among patients with advanced HF, LVAD therapy was associated with pronounced survival benefit, but a higher 2-year readmission rate compared with medical management.

Keywords: advanced heart failure; left ventricular assist device; readmission.

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Conflict of interest statement

Disclosure: J.D.A. reports a relationship with Abbott that includes funding grants. I.G., K.W., and L.C. report a relationship with Abbott that includes consulting or advisory. The other authors have no conflicts of interest to report.

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