Short- and Long-Term Days Alive and Out of Hospital After Left Ventricular Assist Device Implantation

Durable left ventricular assist devices (LVADs) improve the outcomes of patients with advanced heart failure; however, recurrent hospitalization remains a major burden. The days alive and out of hospital (DAOH) is a patient-centered metric that reflects both survival and hospitalization burden; however, data using this measure are limited. This study aimed to evaluate both short- and long-term DAOH following durable LVAD implantation.

We analyzed patients who underwent durable LVAD implantation between 2010 and 2023 using the J-MACS (Japanese Registry for Mechanically Assisted Circulatory Support) registry. DAOH and days lost due to death and hospitalization were evaluated across 3 postimplantation intervals: days 1 to 365 (n=1379), 366 to 730 (n=1136), and 731 to 1095 (n=895).

The mean DAOHs were 216, 309, and 303 days during the first, second, and third years, respectively. During days 1 to 365, most days lost were attributable to the initial hospitalization for LVAD implantation, whereas in subsequent periods, other hospitalizations became the main contributors. Older age and impaired renal function were associated with shorter DAOH during the first 365 days. A lower INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile and implantation in the earlier era were consistently associated with shorter DAOH among all 3 time intervals. Infection, particularly pump-related infection, and neurological dysfunction were the major contributors to hospitalization-related days lost after discharge from the initial hospitalization among all time intervals.

In this nationwide registry analysis, ≈15% of the days remained lost annually after the first year. These findings emphasize the need for improved chronic-phase management and targeted prevention of key complications to optimize long-term outcomes following durable LVAD implantation.