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Updated: Feb 1, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Resource utilization and hospital readmission associated with gastrointestinal bleeding in patients with
Anthony P Carnicelli1,2, Anjali Thakkar1,3, David J Deicicchi1,4
1Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Gastrointestinal bleeding in continuous-flow left ventricular assist device patients leads to high hospital resource use and readmissions. Reducing antiplatelet therapy at discharge may lower readmission rates for these patients.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Gastrointestinal bleeding (GIB) affects up to 40% of patients with continuous-flow (CF) left ventricular assist devices (LVADs).
- LVADs are crucial for heart failure management, but associated complications like GIB require significant healthcare resources.
- High rates of GIB contribute to prolonged hospital stays and frequent readmissions, impacting patient outcomes and healthcare costs.
Purpose of the Study:
- To identify factors influencing hospital resource utilization for GIB in CF-LVAD patients.
- To investigate strategies for decreasing readmission rates following GIB in this population.
- To evaluate the diagnostic yield of imaging and endoscopic procedures for identifying GIB sources.
Main Methods:
- A single-center, retrospective analysis of 57 hospital admissions for GIB in 23 CF-LVAD patients (July 2011-April 2014).
- Data collection included diagnostic imaging, endoscopic procedures, hospital stay duration, and readmission rates (30 and 90 days).
- Statistical analysis assessed the association between interventions (imaging, endoscopy, antiplatelet regimen) and outcomes (diagnostic yield, length of stay, readmissions).
Main Results:
- Diagnostic imaging identified a GIB source in only 23% of admissions; 76 endoscopies were performed with a low diagnostic yield (25% definite/probable source).
- Multiple endoscopies did not improve the likelihood of identifying a bleeding source but were associated with longer hospital stays (p<0.02).
- Readmission rates for GIB were high (33% at 30 days, 53% at 90 days). A reduced antiplatelet regimen at discharge was linked to lower GIB readmission rates (p=0.03).
Conclusions:
- GIB in CF-LVAD patients is a significant clinical challenge associated with substantial resource utilization and high readmission rates.
- Current diagnostic modalities like imaging and endoscopy have limited utility in identifying GIB sources in this cohort.
- Further research and implementation of strategies to optimize antiplatelet therapy and reduce resource use are essential for managing GIB in CF-LVAD patients.
Abstract:
Gastrointestinal bleeding (GIB) occurs in up to 40% of patients with continuous-flow (CF) left ventricular assist devices (LVADs). We sought to identify targets to improve hospital resource utilization and decrease readmissions after GIB. We performed a single-center, retrospective analysis of LVAD-associated GIB resulting in hospital admission between July 2011 and April 2014. Follow-up data were collected through March 2015. We analyzed 57 admissions for GIB in 23 patients. One or more diagnostic imaging study was performed in 47% of admissions, with a definite or probable source of GIB identified in 23%. A total of 76 endoscopies were performed (≥ 1 endoscopy in 79% of admissions, ≥ 2 in 42%). Definite or probable bleeding sources were identified in 25% and 12% of endoscopies, respectively. Patients who underwent multiple endoscopies were no more likely to have a bleeding source identified (OR 1.48; 95% CI 0.50-4.32; p = 0.59) and had longer hospital stays (11.1 vs. 7.8 days, p < 0.02). Readmission rates for GIB at 30 and 90 days were 33% and 53%, respectively. A decrease in antiplatelet regimen at discharge was associated with lower rate of readmission for GIB (OR 0.16; 95% CI 0.03-0.82; p = 0.03) or any cause (OR 0.21; 95% CI 0.05-0.85; p = 0.04) at 30 and 90 days. GIB in patients with CF-LVADs is associated with significant in-hospital resource utilization and high rates of readmission. Imaging and endoscopy are common, but have low diagnostic yield and infrequently result in successful intervention. Strategies to reduce resource utilization and prevent readmission are warranted.
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