ISHLT: Readmissions after LVAD therapy depend on pump

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Causes for hospital readmission differ after left ventricular assist device therapy (LVAD) depending on the pump; however, at six months, freedom from hospital readmission with a rotary LVAD was comparable to medical management of heart failure (HF). Patients with a BMI less than 35 and COPD fared worse, according to research presented April 14 at the 31st annual International Society for Heart & Lung Transplantation scientific sessions in San Diego.

“LVAD therapy has improved management and survival for end-stage CHF patients,” the authors wrote. “The reasons for all cause hospital readmission and frequency have not been reported to date outside of clinical trials.”

To better understand the characteristics of LVAD patients who undergo readmission, Pramod Bonde, MD , assistant professor of surgery at the University of Pittsburgh, and colleagues used the INTERMACS registry to identify adult patients undergoing LVAD implant between June 2006 and March 2010.

Bonde et al identified 1,930 patients, excluding patients with simultaneous right ventricular assist device (RVAD) or BiVADs.
 
Of the 1,930 patients, 82 percent were discharged for at least 24 hours (355 patients had a pulsatile pump and 1,231 had a rotary pump). There were 192 deaths, 664 bridged to heart transplant and 15 with cardiac recovery. The median length of stay was 23 days.

At six months, 55 percent of patients had avoided hospital readmission, which decreased to 39 percent at one year. The authors noted that freedom from readmission was not influenced by age, a prior neurological event, diabetes, intention to treat, diagnosis or INTERMACS profile.

Rotary pump patients fared better at one year with 45 percent having freedom from readmission compared to 27 percent of pulsatile pump patients.

Bonde et al reported that the major causes for a first readmission with pulsatile pumps were device malfunction (18.8 percent), infection (13.4 percent), cardiac (8.2 percent), bleeding (6.2 percent) and syncope (5.3 percent).

The main cause for readmission for rotary pump patients were infection, cardiac, bleeding syncope and elective procedures, which occurred at rates of 17.4 percent, 11.7 percent, 9.8 percent, 6.9 percent and 5.9 percent, respectively.

“Causes for readmission after LVAD therapy are different for rotary vs. pulsatile pumps,” the authors concluded. “Freedom from readmission at six months with a rotary LVAD is comparable when compared to medical management of heart failure but is worse for those with BMI >=35and those with COPD.”