Short-term Care Burden After Left Ventricular Assist Device Implantation and Heart Transplant in the United States

BackgroundHeart transplant (HT) and left ventricular assist devices (LVADs) are treatment options for advanced heart failure refractory to standard therapy. Historically, LVADs have been used as either destination therapy or a bridge to transplant. However, recent changes to the organ allocation system have deprioritized patients on LVADs as transplant recipients, leading to divisive views on the role of an LVAD. Comparative short term care burden with each modality remains unclear. ObjectivesTo describe and compare characteristics, outcomes and cost burden during index hospitalizations, 30-day and 90-day readmissions associated with heart transplants (HT) and durable left ventricular assist devices (LVAD) from a large, national administrative database. MethodsA review of the Nationwide Readmissions Database (NRD) from 2018-2021 describing a cohort identified using ICD-10-CM procedure codes: 02YA0Z0 and 02HA0QZ. ResultsWe identified 27,308 index hospital admissions; 52.4% received LVADs and the remainder received HT. Compared to HT recipients LVAD recipients were older and more likely male, of lower socio-economic status, had longer index hospital stays, and more expensive index hospitalizations. A higher proportion of LVAD recipients required rehospitalizations in 30 days. The most frequent causes of re-hospitalization in the LVAD group at both 30 and 90 days were heart failure, device complications, and gastrointestinal bleeding. The most frequent causes in the HT group at 30 and 90 days were transplant complications, renal dysfunction, and sepsis (at 90 days only). 30 and 90-day rehospitalization costs were greater in the HT group. ConclusionsBoth LVAD and HT had comparable burdens on resource and short-term rehospitalization risk. O_FIG O_LINKSMALLFIG WIDTH=168 HEIGHT=200 SRC="FIGDIR/small/25326911v1_ufig1.gif" ALT="Figure 1"> View larger version (55K): org.highwire.dtl.DTLVardef@e873borg.highwire.dtl.DTLVardef@1d07324org.highwire.dtl.DTLVardef@3777c8org.highwire.dtl.DTLVardef@1990d6e_HPS_FORMAT_FIGEXP M_FIG C_FIG