Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Clinical Management and Definitions
2.3. Hospital Readmission Categorization
2.4. Study Outcomes
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AST | Aspartate aminotransferase |
BTT | Bridge to transplantation |
CF | Centrifugal flow |
DT | Destination therapy |
HF | Heart failure |
INTERMACS | Interagency Registry for Mechanically Assisted Circulatory Support |
MCS | Mechanical circulatory support |
LASSO | Least absolute shrinkage and selection operator |
LVAD | Left ventricular assist device |
LVEF | Left ventricular ejection fraction |
RHC | Right heart catheterization |
VA-ECMO | Veno-arterial extracorporeal membrane oxygenation |
References
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HF/LVAD-Related Readmissions | Non-HF/LVAD-Related Readmissions |
---|---|
Major bleeding | Gastrointestinal disorder |
Major infection | Respiratory distress/failure |
HF exacerbation | Trauma |
Cardiac arrhythmia | Endocrine disorder |
Device malfunction | Chest pain |
Neurological dysfunction | Planned procedure |
Anticoagulant adjustment | Other |
Electrolyte abnormalities | |
Acute or acute on chronic renal failure | |
Pre-syncope/syncope | |
Hypovolemia/hypotension |
Variable | Overall (N = 204) | Non-HF/LVAD-Related Readmission (n = 66) | HF/LVAD-Related Readmission (n = 138) | p-Value |
---|---|---|---|---|
Demographics | ||||
Age, years | 55.7 (13.1) | 54.6 (13.5) | 56.3 (12.9) | 0.399 |
Male sex, n (%) | 171 (83.8) | 56 (84.9) | 115 (83.3) | 0.842 |
Ethnicity and Race | 0.129 | |||
Non-Hispanic White, n (%) | 148 (72.5) | 45 (68.2) | 103 (74.6) | |
Non-Hispanic Black or African American, n (%) | 25 (12.3) | 7 (10.6) | 18 (13.0) | |
Hispanic, n (%) | 17 (8.3) | 10 (15.1) | 7 (5.1) | |
Other, n (%) | 14 (6.9) | 4 (6.1) | 10 (7.3) | |
Body mass index, kg/m2 | 27.9 (5.9) | 27.4 (5.6) | 28.1 (6.0) | 0.411 |
Body surface area, m2 | 2.0 (0.3) | 2.0 (0.3) | 2.0 (0.3) | 0.729 |
Medical and Social History | ||||
Smoking, n (%) | 122 (59.8) | 42 (63.6) | 80 (58.0) | 0.451 |
Ethanol use, n (%) | 127 (62.3) | 42 (63.6) | 85 (61.6) | 0.878 |
Substance use, n (%) | 51 (25.0) | 20 (30.3) | 31 (22.5) | 0.232 |
Diabetes mellitus, n (%) | 81 (39.7) | 25 (37.9) | 56 (40.6) | 0.761 |
Hypertension, n (%) | 115 (56.4) | 35 (53.0) | 80 (58.0) | 0.548 |
Atrial fibrillation, n (%) | 90 (44.1) | 29 (43.9) | 61 (44.2) | 0.972 |
Previous cardiac surgery, n (%) | 38 (18.6) | 5 (7.6) | 33 (23.9) | 0.006 |
Ischemic cardiomyopathy, n (%) | 89 (43.6) | 28 (42.4) | 61 (44.2) | |
NYHA class pre-LVAD | 0.744 | |||
3, n (%) | 61 (29.9) | 21 (31.8) | 40 (29.0) | |
4, n (%) | 143 (70.1) | 45 (68.2) | 98 (71.0) | |
Duration of HF symptoms, months | 86.0 (84.0) | 80.1 (75.2) | 88.8 (88.0) | 0.247 |
Intermacs profile | 0.177 | |||
1 or 2, n (%) | 58 (28.4) | 23 (34.8) | 35 (25.4) | |
3, n (%) | 76 (37.3) | 19 (28.8) | 57 (41.3) | |
4 or more, n (%) | 70 (34.3) | 24 (36.4) | 46 (33.3) | |
LVAD Type | 0.014 | |||
HeartMate 3, n (%) | 63 (30.4) | 28 (42.4) | 34 (24.6) | |
HeartWare, n (%) | 142 (69.6) | 38 (57.6) | 104 (75.4) | |
LVAD Indication | 0.664 | |||
Bridge to transplant, n (%) | 119 (58.3) | 39 (59.1) | 80 (58.0) | |
Destination therapy, n (%) | 73 (35.8) | 22 (33.3) | 51 (36.9) | |
Bridge to decision or recovery, n (%) | 12 (5.9) | 5 (7.6) | 7 (5.1) | |
Distance from implanting center, miles | 568.7 (559.2) | 527.4 (537.8) | 588 (569.9) | 0.467 |
LVAD implant length of stay, days | 25.1 (18.2) | 29.9 (22.1) | 22.9 (15.5) | 0.009 |
Pre-LVAD Supportive Therapies | ||||
Inotrope dependence, n (%) | 144 (70.6) | 44 (66.7) | 100 (72.5) | 0.395 |
IABP, n (%) | 25 (12.3) | 8 (12.1) | 17 (12.3) | 0.968 |
pVAD/VA-ECMO, n (%) | 34 (16.7) | 17 (25.8) | 17 (12.3) | 0.026 |
Pre-LVAD HF Medications | ||||
Beta-blocker, n (%) | 127 (62.3) | 43 (65.2) | 84 (60.9) | 0.644 |
ARNI/ACE-I/ARB, n (%) | 123 (60.3) | 43 (65.2) | 80 (58.0) | 0.361 |
Aldosterone blocker, n (%) | 131 (64.2) | 45 (68.2) | 86 (62.3) | 0.439 |
Diuretics, n (%) | 188 (92.2) | 59 (89.4) | 129 (93.5) | 0.404 |
Pre-LVAD Hemodynamics | ||||
Mean right atrial pressure, mmHg | 11.1 (6.3) | 11.2 (5.9) | 11.0 (6.5) | 0.817 |
Pulmonary capillary wedge pressure, mmHg | 23.9 (8.2) | 24.3 (8.2) | 23.7 (8.2) | 0.595 |
Cardiac index by Fick, L/min/m2 | 1.9 (0.7) | 1.8 (0.5) | 2.0 (0.8) | 0.174 |
Pre-LVAD Laboratory Values | ||||
Hemoglobin, g/dL | 12.1 (2.2) | 12.2 (2.3) | 12.0 (2.2) | 0.477 |
Sodium, mEq/L | 133.2 (5.6) | 132.6 (6.2) | 133.5 (5.3) | 0.287 |
Potassium, mEq/L | 4.1 (0.5) | 4.0 (0.6) | 4.1 (0.5) | 0.513 |
Creatinine, mg/dL | 1.4 (0.6) | 1.4 (0.7) | 1.4 (0.5) | 0.952 |
Blood urea nitrogen, mg/dL | 31.6 (16.3) | 31.7 (16.8) | 31.5 (16.1) | 0.965 |
Aspartate transaminase, mg/dL | 37.2 (38.0) | 45.8 (56.1) | 33.0 (24.5) | 0.024 |
Alanine transaminase, mg/dL | 48.6 (75.7) | 60.4 (107.8) | 43.0 (56.3) | 0.126 |
Albumin, g/dL | 3.7 (0.5) | 3.7 (0.6) | 3.7 (0.5) | 0.601 |
Hemoglobin A1c, g/dL | 6.3 (1.1) | 6.2 (0.8) | 6.3 (1.2) | 0.569 |
Pre-LVAD Echocardiographic Data | ||||
Left ventricular ejection fraction, % | 17.5 (7.5) | 14.8 (6.7) | 18.7 (7.6) | <0.001 |
Left ventricular end-diastolic diameter, cm | 6.6 (1.0) | 6.6 (1.1) | 6.6 (1.0) | 0.973 |
Variable | Overall (N = 204) | Non-HF/LVAD-Related Readmission (n = 66) | HF/LVAD-Related Readmission (n = 138) | p-Value |
---|---|---|---|---|
Intraoperative Data | ||||
Cardiac bypass duration, mins | 88.2 (39.6) | 92.8 (42.7) | 86.0 (38.0) | 0.253 |
Blood product units, n | 4.1 (4.9) | 4.4 (5.0) | 3.9 (4.8) | 0.515 |
Post-LVAD HF Medications | ||||
Beta-blocker, n (%) | 126 (61.8) | 39 (59.1) | 87 (63.0) | 0.645 |
ARNI/ACE-I/ARB, n (%) | 118 (57.8) | 37 (56.1) | 81 (58.7) | 0.763 |
Aldosterone blocker, n (%) | 119 (58.3) | 40 (60.6) | 79 (57.3) | 0.762 |
Diuretics, n (%) | 188 (92.2) | 59 (89.4) | 129 (93.5) | 0.404 |
Post-LVAD Hemodynamics | ||||
Mean right atrial pressure, mmHg | 9.4 (5.2) | 8.9 (5.2) | 9.6 (5.2) | 0.513 |
Pulmonary capillary wedge pressure, mmHg | 13.1 (6.9) | 24.3 (8.2) | 23.7 (8.2) | 0.366 |
Cardiac index by Fick, L/min/m2 | 2.4 (0.5) | 2.4 (0.7) | 2.4 (0.5) | 0.855 |
Pre-Operative Multivariable Model | Pre-, Intra-, and Post-Operative Multivariable Model | ||||||
---|---|---|---|---|---|---|---|
Variable | HR | 95% CI | p-Value | Variable | HR | 95% CI | p-Value |
Substance Use | 1.19 | 1.05–1.34 | 0.005 | Substance Use | 1.23 | 1.15–1.31 | <0.001 |
Previous Cardiac Surgery | 1.26 | 1.08–1.47 | 0.003 | Previous Cardiac Surgery | 1.26 | 1.13–1.41 | <0.001 |
Duration of HF symptoms (quartiles) | 1.10 | 1.07–1.14 | <0.001 | Duration of HF symptoms (quartiles) | 1.12 | 1.09–1.15 | <0.001 |
Pre-operative inotrope dependence | 1.16 | 1.04–1.30 | 0.008 | Pre-operative inotrope dependence | 1.15 | 0.97–1.36 | 0.106 |
Pre-operative percutaneous LVAD/VA-ECMO | 1.10 | 0.95–1.27 | 0.227 | Pre-operative percutaneous LVAD/VA-ECMO | 1.07 | 0.93–1.23 | 0.369 |
HeartWare™ HVAD | 1.35 | 1.08–1.70 | 0.009 | HeartWare™ HVAD | 1.42 | 1.07–1.88 | 0.015 |
Pre-operative LVEF (quartiles) | 1.12 | 1.11–1.13 | <0.001 | Pre-operative LVEF (quartiles) | 1.13 | 1.10–1.15 | <0.001 |
Pre-operative aspartate aminotransferase (quartiles) | 0.98 | 0.97–1.00 | 0.05 | Pre-operative aspartate aminotransferase (quartiles) | 0.98 | 0.93–1.02 | 0.298 |
- | - | - | - | LVAD implant length of stay (days) | 1.12 | 1.09–1.14 | <0.001 |
Harrell’s concordance c-statistic = 0.629 | Harrell’s concordance c-statistic = 0.640 |
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Kyriakopoulos, C.P.; Selzman, C.H.; Giannouchos, T.V.; Mylavarapu, R.; Sideris, K.; Elmer, A.; Vance, N.; Hanff, T.C.; Kagawa, H.; Stehlik, J.; et al. Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices. J. Clin. Med. 2024, 13, 2869. https://doi.org/10.3390/jcm13102869
Kyriakopoulos CP, Selzman CH, Giannouchos TV, Mylavarapu R, Sideris K, Elmer A, Vance N, Hanff TC, Kagawa H, Stehlik J, et al. Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices. Journal of Clinical Medicine. 2024; 13(10):2869. https://doi.org/10.3390/jcm13102869
Chicago/Turabian StyleKyriakopoulos, Christos P., Craig H. Selzman, Theodoros V. Giannouchos, Rohan Mylavarapu, Konstantinos Sideris, Ashley Elmer, Nathan Vance, Thomas C. Hanff, Hiroshi Kagawa, Josef Stehlik, and et al. 2024. "Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices" Journal of Clinical Medicine 13, no. 10: 2869. https://doi.org/10.3390/jcm13102869