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Comparison of Costs, Readmissions and Days out of Hospital at One Year between Heart Transplantation and Continuous Flow LVAD
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The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2013
these adult groups with pediatric IDC samples for potential age-related patterns in dysregulation. Ultimately, we hope to elucidate mechanisms of CL dysregulation and targets for pharmacological therapy. 245 Comparison of Costs, Readmissions and Days out of Hospital at One Year between Heart Transplantation and Continuous Flow LVAD D.J. Goldstein, A. Sileo, L. Baker, J. Nguyen, P. Cotter. Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY. Purpose: With healthcare cost reform firmly on the horizon, it is critical to understand costs associated with new technologies like continuous flow LVAD (CFLVAD) vis-s-vis well established treatments for advanced heart failure like heart transplantation (HT). Scarce data exists describing costs of these two therapies after 1 year of support.
Orleans, FL; 8Division of Cardiothoracic Surgery, The Ohio State University, Columbus, OH; 9Cardiac Surgery, Minneapolis Heart Institute, Minneapolis, MN. Purpose: The safety of patients driving with left ventricular assist devices (LVADs) remains unknown, and policies vary by center. Published opinions are not based on direct data. We sought to examine driving safety with a multi-center assessment in LVAD patients. Methods and Materials: An anonymous survey was sent to ambulatory LVAD patients at 8 different US centers. Collected data included selfreported driving habits and adverse events. Qualitative and quantitative results were analyzed. Results were compared based on the driving policy at each center (3 advise against driving). Results: In total 526 surveys were distributed, with 42% returned and 201 eligible for analysis. Median age group was 56-65 years old; 78% were male. No differences in profiles were noted when grouped by center driving policy. Likewise, age and gender were similar between drivers and non-drivers (56-65 y.o. for both; 80% vs. 67% male, respectively, p¼NS). Patients most commonly drove to conduct errands. Daily distance driven was o16 miles for most, below the US average (37 miles). Surprisingly, 82% reported driving alone.
Number of Patients Driving by Center Policy
Cleared to Drive No Cleared Total
Patients Driving
Patients Not Driving
Total
100 (88%) 71 (82%) 171
14 (12%) 16 (18%) 30
114 87
p¼NS
Methods and Materials: 20 consecutive pts who underwent implantation of a CFLVAD and 20 consecutive pts who underwent HT who were discharged following index surgery and survived at least 1 year represent the study populations. All medical costs incl organ acquisition and device costs, and all direct and indirect costs from day of operation through 365 days were calculated. Hospital charges were converted to costs using hospital specific cost-to-charge ratios. Results: Total costs for 1 yr are shown in Figure 1. Median index LOS was 14 and 23 days for HT and LVAD groups respectively(po0.05). Total of 23 readmissions occurred among 13/20 HT recipients vs 38 readmissions among 17/20 LVAD patients(po0.05). While most significant cost drivers were organ acquisition and device cost, the major difference in total costs were related to more hospital days and higher cost of surgical supplies in LVAD patients. HT patients enjoyed 355 ⫾14 days out of hospital vs 348⫾ 29 days for LVAD. It cost $878/ day and $1091/day to support a HT and LVAD pt for 1 yr respectively. Conclusions: Costs for 1 yr of care are modestly higher for LVAD than for HT patients. Difference attributable to more hospital days and higher surgical costs unrelated to device cost. Reducing index LOS and readmissions for LVAD pts would render these 2 therapies cost equivalent. 246 Hit the Road: A Multicenter Evaluation of Driving with LVADs S. Emani,1 F.D. Pagani,2 P.M. Eckman,3 R.A. Gordon,4 M.A. Brisco,5 C.T.Klodell Jr.6 S.A. Mandras,7 A.K. Hasan,1 C.B. Sai-Sudhakar,8 B.C. Sun.9 1Division of Cardiology, The Ohio State University, Columbus, OH; 2Cardiac Surgery, University of Michigan, Ann Arbor, MI; 3Cardiology Division, University of Minnesota, Minneapolis, MN; 4 Division of Cardiology, Northwestern University, Chicago, IL; 5 Division of Cardiology, University of Pennyslvania, Philadelphia, PA; 6 Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL; 7Division of Cardiology, Ochsner Health System, New
Alarms while driving were reported by 29 patients, but only 2 were for malfunction. While driving, 35 patients report changing batteries; all but 2 stopped to change. Vehicle accidents were reported by 5 patients (3%); none were classified as serious and none were due to malfunction. Conclusions: Driving with an LVAD is common, regardless of institutional policy, and has a low rate of adverse outcomes. These data suggest driving may be reasonably safe for stable patients, however more conclusive data is necessary. 247 Cost of 1-Year LVAD Destination Therapy in Chronic Heart Failure; a Comparison with Heart Transplantation B. Meyns,1 S. Jacobs,1 K. Van den Bossche,1 J. Verhoeven,1 R.R. Bostic,3 J. Vanhaecke,2 J. Van Cleemput,2 W. Droogne.2 1 Department Cardiac Surgery, KULeuven, Leuven, Belgium;
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2013
these adult groups with pediatric IDC samples for potential age-related patterns in dysregulation. Ultimately, we hope to elucidate mechanisms of CL dysregulation and targets for pharmacological therapy. 245 Comparison of Costs, Readmissions and Days out of Hospital at One Year between Heart Transplantation and Continuous Flow LVAD D.J. Goldstein, A. Sileo, L. Baker, J. Nguyen, P. Cotter. Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY. Purpose: With healthcare cost reform firmly on the horizon, it is critical to understand costs associated with new technologies like continuous flow LVAD (CFLVAD) vis-s-vis well established treatments for advanced heart failure like heart transplantation (HT). Scarce data exists describing costs of these two therapies after 1 year of support.
Orleans, FL; 8Division of Cardiothoracic Surgery, The Ohio State University, Columbus, OH; 9Cardiac Surgery, Minneapolis Heart Institute, Minneapolis, MN. Purpose: The safety of patients driving with left ventricular assist devices (LVADs) remains unknown, and policies vary by center. Published opinions are not based on direct data. We sought to examine driving safety with a multi-center assessment in LVAD patients. Methods and Materials: An anonymous survey was sent to ambulatory LVAD patients at 8 different US centers. Collected data included selfreported driving habits and adverse events. Qualitative and quantitative results were analyzed. Results were compared based on the driving policy at each center (3 advise against driving). Results: In total 526 surveys were distributed, with 42% returned and 201 eligible for analysis. Median age group was 56-65 years old; 78% were male. No differences in profiles were noted when grouped by center driving policy. Likewise, age and gender were similar between drivers and non-drivers (56-65 y.o. for both; 80% vs. 67% male, respectively, p¼NS). Patients most commonly drove to conduct errands. Daily distance driven was o16 miles for most, below the US average (37 miles). Surprisingly, 82% reported driving alone.
Number of Patients Driving by Center Policy
Cleared to Drive No Cleared Total
Patients Driving
Patients Not Driving
Total
100 (88%) 71 (82%) 171
14 (12%) 16 (18%) 30
114 87
p¼NS
Methods and Materials: 20 consecutive pts who underwent implantation of a CFLVAD and 20 consecutive pts who underwent HT who were discharged following index surgery and survived at least 1 year represent the study populations. All medical costs incl organ acquisition and device costs, and all direct and indirect costs from day of operation through 365 days were calculated. Hospital charges were converted to costs using hospital specific cost-to-charge ratios. Results: Total costs for 1 yr are shown in Figure 1. Median index LOS was 14 and 23 days for HT and LVAD groups respectively(po0.05). Total of 23 readmissions occurred among 13/20 HT recipients vs 38 readmissions among 17/20 LVAD patients(po0.05). While most significant cost drivers were organ acquisition and device cost, the major difference in total costs were related to more hospital days and higher cost of surgical supplies in LVAD patients. HT patients enjoyed 355 ⫾14 days out of hospital vs 348⫾ 29 days for LVAD. It cost $878/ day and $1091/day to support a HT and LVAD pt for 1 yr respectively. Conclusions: Costs for 1 yr of care are modestly higher for LVAD than for HT patients. Difference attributable to more hospital days and higher surgical costs unrelated to device cost. Reducing index LOS and readmissions for LVAD pts would render these 2 therapies cost equivalent. 246 Hit the Road: A Multicenter Evaluation of Driving with LVADs S. Emani,1 F.D. Pagani,2 P.M. Eckman,3 R.A. Gordon,4 M.A. Brisco,5 C.T.Klodell Jr.6 S.A. Mandras,7 A.K. Hasan,1 C.B. Sai-Sudhakar,8 B.C. Sun.9 1Division of Cardiology, The Ohio State University, Columbus, OH; 2Cardiac Surgery, University of Michigan, Ann Arbor, MI; 3Cardiology Division, University of Minnesota, Minneapolis, MN; 4 Division of Cardiology, Northwestern University, Chicago, IL; 5 Division of Cardiology, University of Pennyslvania, Philadelphia, PA; 6 Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL; 7Division of Cardiology, Ochsner Health System, New
Alarms while driving were reported by 29 patients, but only 2 were for malfunction. While driving, 35 patients report changing batteries; all but 2 stopped to change. Vehicle accidents were reported by 5 patients (3%); none were classified as serious and none were due to malfunction. Conclusions: Driving with an LVAD is common, regardless of institutional policy, and has a low rate of adverse outcomes. These data suggest driving may be reasonably safe for stable patients, however more conclusive data is necessary. 247 Cost of 1-Year LVAD Destination Therapy in Chronic Heart Failure; a Comparison with Heart Transplantation B. Meyns,1 S. Jacobs,1 K. Van den Bossche,1 J. Verhoeven,1 R.R. Bostic,3 J. Vanhaecke,2 J. Van Cleemput,2 W. Droogne.2 1 Department Cardiac Surgery, KULeuven, Leuven, Belgium;