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Published on: August 16, 2021
Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in
Feng Li1, Alice Hinton2, Alan Chen3
1Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd Floor Office Tower, Columbus, OH, 43210, USA.
Insights
Continuous-flow left ventricular assist devices (CF-LVADs) increase healthcare utilization for gastrointestinal bleeding (GIB) but do not raise mortality. Patients with CF-LVADs experienced longer hospital stays and higher costs due to GIB.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Left ventricular assist devices (LVADs) are crucial for end-stage heart failure management, necessitating systemic anticoagulation.
- Gastrointestinal bleeding (GIB) is a significant complication following LVAD implantation.
Purpose of the Study:
- To evaluate the impact of continuous-flow (CF) LVADs on patient outcomes during hospitalizations for GIB.
- To compare outcomes between patients with and without CF-LVADs admitted for GIB.
Main Methods:
- A cross-sectional study using the Nationwide Inpatient Sample (2010-2012) in the CF-LVAD era.
- Inclusion of adult hospitalizations with a primary GIB diagnosis.
- Comparison of CF-LVAD patients (cases) versus non-CF-LVAD patients (controls) using univariate and multivariate analyses, focusing on in-hospital mortality, length of stay, and hospitalization costs.
Main Results:
- Among 1,002,299 GIB hospitalizations, 1112 (0.11%) involved CF-LVAD patients.
- Bleeding angiodysplasia was the primary cause of GIB in 35.4% of CF-LVAD patients.
- Multivariate analysis showed CF-LVADs were not associated with increased mortality (OR 0.53), but independently predicted prolonged hospitalization (3.5 days) and higher costs ($37,032).
Conclusions:
- CF-LVAD implantation is associated with increased healthcare utilization for GIB but not with adverse mortality outcomes.
- Despite anticoagulation, comorbidities, and delayed endoscopy, CF-LVAD patients with GIB did not experience higher mortality.
- Findings are critical as CF-LVADs dominate the LVAD market and present a higher GIB risk than earlier models.
Background:
Left ventricular assist devices (LVADs) are being utilized for management of end-stage heart failure and require systemic anticoagulation. Gastrointestinal bleeding (GIB) is one of the most common adverse events following LVAD implantation.
Aim:
To investigate the impact of continuous-flow (CF) LVAD implants on outcomes of patients admitted with GIB.
Methods:
This is a cross-sectional study utilizing the Nationwide Inpatient Sample in the CF-LVAD era from 2010 to 2012. All adult admissions with a primary diagnosis of GIB were included. Among hospitalizations with GIB, patients with (cases) and without (controls) CF-LVAD implants were compared using univariate and multivariate analyses. The main outcome measurements were in-hospital mortality, length of stay, and hospitalization costs.
Results:
Among 1,002,299 hospitalizations for GIB, 1112 (0.11%) patients had CF-LVADs. Bleeding angiodysplasia accounted for a majority of GIB in CF-LVAD patients (35.4% of 1112). Multivariate analysis adjusting for demographic, hospital and etiological differences, site of GIB, and patient comorbidities revealed that CF-LVADs were not adversely associated with mortality in GIB (OR 0.53, 95% CI 0.07-4.15). However, CF-LVADs independently accounted for prolonged hospitalization (3.5 days, 95% CI 2.6-4.6) and higher hospital charges ($37,032, 95% CI $7991-$66,074).
Conclusions:
In patients admitted with GIB, CF-LVAD implantation accounts for higher healthcare utilization, but is not adversely associated with mortality despite therapeutic anticoagulation, increased comorbidities, and comparatively delayed endoscopy. These findings are relevant as CF-LVADs are the dominant type of LVAD and are associated with increased risk of GIB compared to their predecessors.
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