Care fragmentation predicts 90-day durable ventricular assist device outcomes

Area of Science:

• Cardiology
• Health Services Research
• Medical Informatics

Background:

• Durable ventricular assist device (VAD) implantation is a critical therapy for advanced heart failure.
• Optimizing patient outcomes after VAD implantation requires seamless multidisciplinary care.
• The impact of care delivery network fragmentation on VAD outcomes remains understudied.

Purpose of the Study:

• To investigate the association between fragmentation of the care delivery network and in-hospital and 90-day outcomes after durable VAD implantation.
• To identify potential targets for improving patient care and outcomes in VAD recipients.

Main Methods:

• A cohort study utilizing Medicare claims linked with the STS Intermacs registry.
• Care network fragmentation was quantified using provider data from the previous year.
• Multivariable regression analysis assessed the association between network fragmentation and infection/mortality risks.

Main Results:

• The study included 5159 VAD patients; 11.2% mortality and 27.6% infection within 90 days.
• Increased network fragmentation correlated with higher in-hospital and 90-day infection probabilities (P < .05).
• Network fragmentation showed a trend towards predicting 90-day mortality, though not statistically significant after adjustment.

Conclusions:

• Fragmentation in VAD care delivery networks is linked to increased infection rates post-implantation.
• Addressing care network fragmentation presents a potential strategy for improving VAD patient outcomes.
• Further research into optimizing care coordination networks is warranted for VAD recipients.