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Does Preoperative Mitral Regurgitation Influence Outcomes After Continuous-Flow Left Ventricular Assist Device Implantation?
S34
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
7( 2) Higher Quality of Caregiver Support Is Associated with Post-Transplant Adherence at 6 Months J.M. Rowan ,1 C.J. Gries,1 A.J. Devito Dabbs.2 1PACCM, UPMC Pittsburgh, PA, Pittsburgh, PA; 2University of Pittsburgh School of Nursing, UPMC - Pittsburgh, PA, Pittsburgh, PA. Purpose: Most transplant centers require recipients to have a designated lay caregiver to assist with recovery and adherence to the new regimen; however, the quality of caregiver support may vary. Identifying patients who may require additional support may be crucial to promote adherence and graft survival after lung transplant. This study assesses whether the quality of caregiver support is associated with self-reported adherence. Methods: Consecutive lung transplant recipients provided sociodemographic data and completed the 20-item Dyadic Adjustment Scale (DAS), a validated self-report measure of quality of caregiver support as part of the baseline assessment for a RCT. Six months postdischarge, patients completed the Health Habits Assessment (HHA) a self-report measure of adherence to elements of the post-transplant regimen. Univariate and multivariate linear regression was used to assess the relationship between the DAS and post-lung transplant adherence at 6 months. Results: A total of 199 patients were enrolled (response rate: 76%). Median (IQR) age was 62 (51; 68). Patients were more likely to be male (55.2%) and white (91.0%). The DAS ranged from 29-90, and the median (IQR) score was 77 (68; 87). Univariate analysis showed that a higher level of caregiver support was associated with higher rate of self-reported adherence to the medical regimen (p= 0.03). After adjusting for age, race and gender, a higher quality of caregiver support was associated with higher level of adherence at 6 months post discharge (p= 0.05). Conclusion: The quality of caregiver support was positively associated with self-reported adherence to the medical regimen at 6 months after discharge for lung transplantation. These findings will inform the development and evaluation of an intervention that provides additional support for patients with low caregiver support in order to improve adherence and health outcomes after lung transplantation.
Conclusion: Despite growth in the use of acute MCS from 2007-2011, the proportion of patients with cardiogenic shock receiving these devices remains small, and few patients receive salvage therapy with acute MCS after failing IABP support. Table 1. Comparison of patient characteristics and outcomes in the iIABP and iMCS groups. Characteristics
iIABP (n = 25 247)
Admitted through 14 458 (57.3) emergency department, No. (%) Admission type, No. (%)* Not a transfer 16 873 (67.0) Transferred from an acute 7884 (31.3) care hospital Transferred from another 426 (1.7) type of health facility Primary diagnosis, No. (%) AMI or CAD 17 947 (71.1) CHF 2359 (9.3) Other 4940 (19.6) Hospital course, No. (%) Intubation 8887 (35.2) Cardiopulmonary 2385 (9.4) resuscitation Heart transplant 401 (1.6) Permanent device 1071 (4.2) Length of stay, Median 11 (5 - 20) (IQR), d In-hospital mortality, 7132 (28.2) No. (%) Cost of hospitalization per $5366 ($4125 day, Median (IQR) $7461)
iMCS (n = 1064) p 302 (28.4)
< 0.001
< 0.001 448 (42.1) 571 (53.7) 45 (4.2) < 0.001 434 (40.8) 277 (26.1) 352 (33.1) 270 (25.4) 83 (7.8)
< 0.001 0.071
127 (11.9) 238 (22.3) 20 (7 - 42)
< 0.001 < 0.001 < 0.001
439 (41.3)
< 0.001
$8162 ($5684 $12 870)
< 0.001
7( 4)
Outcome and Survival Following Cardiogenic Shock Supported By IABP Versus Mechanical Circulatory Support Devices in a National Cohort R.J. Stretch ,1 P. Bonde.2 1Bonde Artificial Heart Lab, Yale School of Medicine, New Haven, CT; 2Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT.
Does Preoperative Mitral Regurgitation Influence Outcomes After Continuous-Flow Left Ventricular Assist Device Implantation? S. Maltais ,1 V. Tchantchaleishvili,2 N.A. Haglund,1 J. Cowger,1 M.E. Davis,1 M. Keebler,1 L.D. Joyce,1 R.C. Daly,1 S.J. Park,3 K.D. Aaronson,1 F.D. Pagani,3 J.M. Stulak.3 1Vanderbilt University Medical Cente, Nashville, TN; 2University of Rochester Medical Center, Rochester, NY; 3Mayo Clinic, Rochester, MN.
Purpose: To compare the demographics, hospital course and outcomes of patients with cardiogenic shock where intention to treat was with intraaortic balloon pump (IABP) or acute mechanical circulatory support (MCS). Methods: All adult patients with cardiogenic shock who received either IABP or acute MCS from 2008 to 2011 in the Nationwide Inpatient Sample (NIS) were analyzed. We classified IABP use with or without subsequent MCS as intention to treat with balloon pump (iIABP). Intention to treat with acute MCS was defined as use of either percutaneous or non-percutaneous MCS without prior or subsequent IABP use (iMCS). Results: A total of 26 311 patients (25 247 iIABP and 1064 iMCS) met the inclusion criteria. Only 3.7% (932) of patients in the iIABP group later received acute MCS. In the iMCS group, 484 received percutaneous MCS, 557 received non-percutaneous MCS and 24 received both. The iMCS group was significantly younger than the iIABP group (median 55 [46-66] years vs 64 [55-73] years) (p < 0.01) and a greater proportion of patients had ≥ 3 Elixhauser comorbidities (61.7% [656] vs 54.7% [13 802]). Patients receiving acute MCS after failing IABP treatment had a greater mortality rate than those receiving IABP alone (45.0% vs 27.6%) (p < 0.01). A third of patients could be bridged to transplant (11.9%) or permanent LVAD (22.3%) in the iMCS group vs 5.8% in the iIABP group (Table 1). Significant predictors of in-hospital mortality were age ≥ 65, transfer from an acute care hospital or another facility, and a primary diagnosis other than AMI, CAD or CHF (p < 0.01). Other independent predictors of mortality included cardiopulmonary resuscitation (OR 4.55, 95% CI 3.71-5.58) and intubation (OR 1.75, 95% CI 1.53-2.00).
Purpose: Mitral regurgitation (MR) is prevalent in heart failure patients. The influence of significant preoperative MR on outcomes after Left Ventricular Assist Device (LVAD) implantation remains to be determined. We examined the impact of MR with survival and LVAD-related complications. Methods: From October 1996 to August 2013, 756 patients were implanted with a continuous flow (CF) LVAD at 3 major institutions (HeartMate II, n= 410, 80.7%, and HeartWare, n= 98, 19.3%). Patients were divided in two groups based on degree of MR: severe MR (MR group, n= 189, 38.5%), or less than severe MR (lessMR group, n= 302, 61.5%). Kaplan-Meier survival and multiple Cox regression analysis models were used to evaluate the interaction of MR with survival, and CF LVAD-related complications (hemolysis, pump thrombus, stroke, and gastrointestinal bleeding. Results: Median age (MR 60 vs. lessMR 58 years old, p= 0.19), and male gender (MR 77.7% vs. lessMR 81.1%, p= 0.42) were comparable. Ischemic etiology was similarly distributed (MR= 4 6%, vs. lessMR= 5 0.7%, p= 0 .35). Median follow up was higher in the MR group (391 days, range 161-752, vs. 311.5 days, range 122-649, p< 0.05). Interestingly, analysis revealed a survival benefit in patients with severe preoperative MR (p< 0.01, Figure 1). The concomitant presence or absence of severe TR (severe TR vs. lessTR) revealed survival was worse in the lessMR, severe TR group (p< 0 .01). Survival was preserved if TR was associated with severe MR (p= 0.12). Stratification by left ventricle diastolic dimensions did not influence survival. Severe preoperative MR had
7 ( 3)
Abstracts S35 not effect on LVAD related complications. Cox proportional hazards model confirmed the interaction between MR and survival (HR: 0.62; p= 0.04). Conclusion: Severe preoperative MR seems to be associated with improved survival after CF-LVAD implantation. TR influenced survival only for patients with lessMR. These findings could argue against concomitant mitral surgery at the time of LVAD implant.
7( 6) The Impact of LVAD Program Volume and Transplant Status on Cost, Quality, and Survival in in the UHC Database 2010-2012 S.C. Silvestry , A. Itoh, T. Kazui, S.M. Prasad. Surgery/Cardiac Surgery, Washington University School of Medicine, Saint Louis, MO. 7( 5) Does Metabolic Syndrome Affect Outcomes After Left Ventricular Assist Device Implantation? S. Maltais ,1 N.A. Haglund,1 J. Cowger,1 M.E. Davis,1 L.D. Joyce,1 R.C. Daly,1 S.J. Park,1 K. Aaronson,1 F. Pagani,1 J.M. Stulak.2 1Vanderbilt University Medical Cente, Nashville, TN; 2Mayo Clinic, Rochester, MN. Purpose: Metabolic syndrome (MetS) is prevelant in heart failure patients. An increasing number of patients are implanted with a left ventricular assist device (LVAD). We sought to determine the impact of MetS and its association with survival and LVAD-related complications. Methods: From October 1996 to August 2013, 756 patients were implanted with a LVAD at 3 institutions. Contemporary continuous-flow (CF) LVADs (n= 505) were analyzed (HeartMate-II, 81%; HeartWare, 19%). MetS patients (MetS= 171, 34%) met at least 3 of the International Diabetes Federation criteria for MetS. Patients were analyzed in 4 age groups (17-49, 49-59, 59-66, 66-80). Kaplan-Meier survival and multivariate Cox regression models were used. Results: Age, gender, mean follow up time, number of CF-LVAD related adverse events and survival were comparable between groups (all p> 0.05). Body mass index (35±4 vs 26±5), hypertension (71% vs 37%), diabetes (61% vs 24%), and hyperlipidemia (74% vs 43%) were higher in the MetS group (all p< 0.001). Increased age was associated with a shorter time to first adverse event or death (p= 0.007). Males with MetS had a significantly lower survival compared to the NO MetS group (p= 0.04). Patients with MetS and in the oldest age group had a lower survival when compared to patients with NO MetS (p= 0.049). Time to the first adverse event or death was significantly shorter in older patients with MetS (p= 0.003) (Figure 1), with time to first gastrointestinal bleed (p= 0 .035) and pump thrombus/hemolysis (p= 0 .01) being among the most significant. There was a significant interaction between age stratum, MetS and time to first CF-LVAD-related adverse event or death (HR: 1.22 [0.84-1.78]; p= 0.04). Conclusion: Older male patients with MetS have decreased survival after CF-LVAD implantation and time to first CF-LVAD related adverse event is shorter in this group. The presence of MetS in patients implanted with a CF-LVAD is clinically important, and warrants greater recognition and optimization prior to CF-LVAD implantation.
Purpose: To analyze the impact of VAD program volume and heart transplant/left ventricular assist device programs(VAD/Txp) versus LVAD only (VAD) program status on implant mortality, cost, readmission and length of stay in a large U.S. administrative database. Methods: The University Health System Consortium (UHC) was queried for LVAD implantation (CPT 37.66). During 2010-2012, there were 4667 LVAD implants in 66 centers. From 2010-2012, VAD centers implanted 99 LVADS and VAD/Txp implanted 4568 LVADS. Observed mortality, readmission,and length of stay data were obtained for all centers. Mortality, length of stay, readmissions and cost indices (Observed/Expected) were calculated according to UHC models. These variables (observed and indexed) were analyzed in relation to case volume using regression and correlation analysis. Results: Mean VAD implants increased for both groups from 2010-2012. VAD only centers implanted significantly less LVADs/center than VAD/Txp centers for each year (Table). In the VAD/Txp centers, volume, expected mortality and length of stay were higher than in VAD alone centers. Length of stay index, mortality index, cost index and readmission index did not statistically differ for VAD vs VAD/ Txp centers. Increasing volume was weakly associated with decreased mortality only (r= -0.29*, p< 0.05) for 2010 only. Increasing center volume was not significantly associated with improved LOS, mortality, cost or readmission indices. Conclusion: During 2010-2012, the majority of LVAD implants in occurred in VAD/Txp centers. VAD centers achieved similar cost and quality outcomes for a smaller number of less acute patients compared to VAD/Txp centers.There was no consistent relationship between increasing center volume and improved, cost, quality and mortality. These data bear direct impact on quality and volume goals for all programs and the dissemination of VAD centers into the community.
VAD vs VAD/Txp LVAD Implants UHC database 2010-2012 2010
2011
VAD/ VAD(n= 7) Txp(n= 56)
VAD(n= 8)
VAD/ Txp(n= 57)
VAD(n= 8)
VAD/ Txp(n= 58)
Average LVAD Implants (SD)
2.0(1.1)
24.1 (13.9)
3.9(2.6)
27.5(13.5)
6.8(3.0)
28.5(13.0)
LOS Index
0.52
1.01
0.95
0.93
0.83
0.88
Mortality Index
3.59
1.25
1.91
0.93
1.88
0.94
Direct Cost Index 0.64
0.95
0.87
0.98
0.86
0.99
Readmission Index
1.00
1.22
0.99
1.17
0.99
0.33
2012
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
7( 2) Higher Quality of Caregiver Support Is Associated with Post-Transplant Adherence at 6 Months J.M. Rowan ,1 C.J. Gries,1 A.J. Devito Dabbs.2 1PACCM, UPMC Pittsburgh, PA, Pittsburgh, PA; 2University of Pittsburgh School of Nursing, UPMC - Pittsburgh, PA, Pittsburgh, PA. Purpose: Most transplant centers require recipients to have a designated lay caregiver to assist with recovery and adherence to the new regimen; however, the quality of caregiver support may vary. Identifying patients who may require additional support may be crucial to promote adherence and graft survival after lung transplant. This study assesses whether the quality of caregiver support is associated with self-reported adherence. Methods: Consecutive lung transplant recipients provided sociodemographic data and completed the 20-item Dyadic Adjustment Scale (DAS), a validated self-report measure of quality of caregiver support as part of the baseline assessment for a RCT. Six months postdischarge, patients completed the Health Habits Assessment (HHA) a self-report measure of adherence to elements of the post-transplant regimen. Univariate and multivariate linear regression was used to assess the relationship between the DAS and post-lung transplant adherence at 6 months. Results: A total of 199 patients were enrolled (response rate: 76%). Median (IQR) age was 62 (51; 68). Patients were more likely to be male (55.2%) and white (91.0%). The DAS ranged from 29-90, and the median (IQR) score was 77 (68; 87). Univariate analysis showed that a higher level of caregiver support was associated with higher rate of self-reported adherence to the medical regimen (p= 0.03). After adjusting for age, race and gender, a higher quality of caregiver support was associated with higher level of adherence at 6 months post discharge (p= 0.05). Conclusion: The quality of caregiver support was positively associated with self-reported adherence to the medical regimen at 6 months after discharge for lung transplantation. These findings will inform the development and evaluation of an intervention that provides additional support for patients with low caregiver support in order to improve adherence and health outcomes after lung transplantation.
Conclusion: Despite growth in the use of acute MCS from 2007-2011, the proportion of patients with cardiogenic shock receiving these devices remains small, and few patients receive salvage therapy with acute MCS after failing IABP support. Table 1. Comparison of patient characteristics and outcomes in the iIABP and iMCS groups. Characteristics
iIABP (n = 25 247)
Admitted through 14 458 (57.3) emergency department, No. (%) Admission type, No. (%)* Not a transfer 16 873 (67.0) Transferred from an acute 7884 (31.3) care hospital Transferred from another 426 (1.7) type of health facility Primary diagnosis, No. (%) AMI or CAD 17 947 (71.1) CHF 2359 (9.3) Other 4940 (19.6) Hospital course, No. (%) Intubation 8887 (35.2) Cardiopulmonary 2385 (9.4) resuscitation Heart transplant 401 (1.6) Permanent device 1071 (4.2) Length of stay, Median 11 (5 - 20) (IQR), d In-hospital mortality, 7132 (28.2) No. (%) Cost of hospitalization per $5366 ($4125 day, Median (IQR) $7461)
iMCS (n = 1064) p 302 (28.4)
< 0.001
< 0.001 448 (42.1) 571 (53.7) 45 (4.2) < 0.001 434 (40.8) 277 (26.1) 352 (33.1) 270 (25.4) 83 (7.8)
< 0.001 0.071
127 (11.9) 238 (22.3) 20 (7 - 42)
< 0.001 < 0.001 < 0.001
439 (41.3)
< 0.001
$8162 ($5684 $12 870)
< 0.001
7( 4)
Outcome and Survival Following Cardiogenic Shock Supported By IABP Versus Mechanical Circulatory Support Devices in a National Cohort R.J. Stretch ,1 P. Bonde.2 1Bonde Artificial Heart Lab, Yale School of Medicine, New Haven, CT; 2Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT.
Does Preoperative Mitral Regurgitation Influence Outcomes After Continuous-Flow Left Ventricular Assist Device Implantation? S. Maltais ,1 V. Tchantchaleishvili,2 N.A. Haglund,1 J. Cowger,1 M.E. Davis,1 M. Keebler,1 L.D. Joyce,1 R.C. Daly,1 S.J. Park,3 K.D. Aaronson,1 F.D. Pagani,3 J.M. Stulak.3 1Vanderbilt University Medical Cente, Nashville, TN; 2University of Rochester Medical Center, Rochester, NY; 3Mayo Clinic, Rochester, MN.
Purpose: To compare the demographics, hospital course and outcomes of patients with cardiogenic shock where intention to treat was with intraaortic balloon pump (IABP) or acute mechanical circulatory support (MCS). Methods: All adult patients with cardiogenic shock who received either IABP or acute MCS from 2008 to 2011 in the Nationwide Inpatient Sample (NIS) were analyzed. We classified IABP use with or without subsequent MCS as intention to treat with balloon pump (iIABP). Intention to treat with acute MCS was defined as use of either percutaneous or non-percutaneous MCS without prior or subsequent IABP use (iMCS). Results: A total of 26 311 patients (25 247 iIABP and 1064 iMCS) met the inclusion criteria. Only 3.7% (932) of patients in the iIABP group later received acute MCS. In the iMCS group, 484 received percutaneous MCS, 557 received non-percutaneous MCS and 24 received both. The iMCS group was significantly younger than the iIABP group (median 55 [46-66] years vs 64 [55-73] years) (p < 0.01) and a greater proportion of patients had ≥ 3 Elixhauser comorbidities (61.7% [656] vs 54.7% [13 802]). Patients receiving acute MCS after failing IABP treatment had a greater mortality rate than those receiving IABP alone (45.0% vs 27.6%) (p < 0.01). A third of patients could be bridged to transplant (11.9%) or permanent LVAD (22.3%) in the iMCS group vs 5.8% in the iIABP group (Table 1). Significant predictors of in-hospital mortality were age ≥ 65, transfer from an acute care hospital or another facility, and a primary diagnosis other than AMI, CAD or CHF (p < 0.01). Other independent predictors of mortality included cardiopulmonary resuscitation (OR 4.55, 95% CI 3.71-5.58) and intubation (OR 1.75, 95% CI 1.53-2.00).
Purpose: Mitral regurgitation (MR) is prevalent in heart failure patients. The influence of significant preoperative MR on outcomes after Left Ventricular Assist Device (LVAD) implantation remains to be determined. We examined the impact of MR with survival and LVAD-related complications. Methods: From October 1996 to August 2013, 756 patients were implanted with a continuous flow (CF) LVAD at 3 major institutions (HeartMate II, n= 410, 80.7%, and HeartWare, n= 98, 19.3%). Patients were divided in two groups based on degree of MR: severe MR (MR group, n= 189, 38.5%), or less than severe MR (lessMR group, n= 302, 61.5%). Kaplan-Meier survival and multiple Cox regression analysis models were used to evaluate the interaction of MR with survival, and CF LVAD-related complications (hemolysis, pump thrombus, stroke, and gastrointestinal bleeding. Results: Median age (MR 60 vs. lessMR 58 years old, p= 0.19), and male gender (MR 77.7% vs. lessMR 81.1%, p= 0.42) were comparable. Ischemic etiology was similarly distributed (MR= 4 6%, vs. lessMR= 5 0.7%, p= 0 .35). Median follow up was higher in the MR group (391 days, range 161-752, vs. 311.5 days, range 122-649, p< 0.05). Interestingly, analysis revealed a survival benefit in patients with severe preoperative MR (p< 0.01, Figure 1). The concomitant presence or absence of severe TR (severe TR vs. lessTR) revealed survival was worse in the lessMR, severe TR group (p< 0 .01). Survival was preserved if TR was associated with severe MR (p= 0.12). Stratification by left ventricle diastolic dimensions did not influence survival. Severe preoperative MR had
7 ( 3)
Abstracts S35 not effect on LVAD related complications. Cox proportional hazards model confirmed the interaction between MR and survival (HR: 0.62; p= 0.04). Conclusion: Severe preoperative MR seems to be associated with improved survival after CF-LVAD implantation. TR influenced survival only for patients with lessMR. These findings could argue against concomitant mitral surgery at the time of LVAD implant.
7( 6) The Impact of LVAD Program Volume and Transplant Status on Cost, Quality, and Survival in in the UHC Database 2010-2012 S.C. Silvestry , A. Itoh, T. Kazui, S.M. Prasad. Surgery/Cardiac Surgery, Washington University School of Medicine, Saint Louis, MO. 7( 5) Does Metabolic Syndrome Affect Outcomes After Left Ventricular Assist Device Implantation? S. Maltais ,1 N.A. Haglund,1 J. Cowger,1 M.E. Davis,1 L.D. Joyce,1 R.C. Daly,1 S.J. Park,1 K. Aaronson,1 F. Pagani,1 J.M. Stulak.2 1Vanderbilt University Medical Cente, Nashville, TN; 2Mayo Clinic, Rochester, MN. Purpose: Metabolic syndrome (MetS) is prevelant in heart failure patients. An increasing number of patients are implanted with a left ventricular assist device (LVAD). We sought to determine the impact of MetS and its association with survival and LVAD-related complications. Methods: From October 1996 to August 2013, 756 patients were implanted with a LVAD at 3 institutions. Contemporary continuous-flow (CF) LVADs (n= 505) were analyzed (HeartMate-II, 81%; HeartWare, 19%). MetS patients (MetS= 171, 34%) met at least 3 of the International Diabetes Federation criteria for MetS. Patients were analyzed in 4 age groups (17-49, 49-59, 59-66, 66-80). Kaplan-Meier survival and multivariate Cox regression models were used. Results: Age, gender, mean follow up time, number of CF-LVAD related adverse events and survival were comparable between groups (all p> 0.05). Body mass index (35±4 vs 26±5), hypertension (71% vs 37%), diabetes (61% vs 24%), and hyperlipidemia (74% vs 43%) were higher in the MetS group (all p< 0.001). Increased age was associated with a shorter time to first adverse event or death (p= 0.007). Males with MetS had a significantly lower survival compared to the NO MetS group (p= 0.04). Patients with MetS and in the oldest age group had a lower survival when compared to patients with NO MetS (p= 0.049). Time to the first adverse event or death was significantly shorter in older patients with MetS (p= 0.003) (Figure 1), with time to first gastrointestinal bleed (p= 0 .035) and pump thrombus/hemolysis (p= 0 .01) being among the most significant. There was a significant interaction between age stratum, MetS and time to first CF-LVAD-related adverse event or death (HR: 1.22 [0.84-1.78]; p= 0.04). Conclusion: Older male patients with MetS have decreased survival after CF-LVAD implantation and time to first CF-LVAD related adverse event is shorter in this group. The presence of MetS in patients implanted with a CF-LVAD is clinically important, and warrants greater recognition and optimization prior to CF-LVAD implantation.
Purpose: To analyze the impact of VAD program volume and heart transplant/left ventricular assist device programs(VAD/Txp) versus LVAD only (VAD) program status on implant mortality, cost, readmission and length of stay in a large U.S. administrative database. Methods: The University Health System Consortium (UHC) was queried for LVAD implantation (CPT 37.66). During 2010-2012, there were 4667 LVAD implants in 66 centers. From 2010-2012, VAD centers implanted 99 LVADS and VAD/Txp implanted 4568 LVADS. Observed mortality, readmission,and length of stay data were obtained for all centers. Mortality, length of stay, readmissions and cost indices (Observed/Expected) were calculated according to UHC models. These variables (observed and indexed) were analyzed in relation to case volume using regression and correlation analysis. Results: Mean VAD implants increased for both groups from 2010-2012. VAD only centers implanted significantly less LVADs/center than VAD/Txp centers for each year (Table). In the VAD/Txp centers, volume, expected mortality and length of stay were higher than in VAD alone centers. Length of stay index, mortality index, cost index and readmission index did not statistically differ for VAD vs VAD/ Txp centers. Increasing volume was weakly associated with decreased mortality only (r= -0.29*, p< 0.05) for 2010 only. Increasing center volume was not significantly associated with improved LOS, mortality, cost or readmission indices. Conclusion: During 2010-2012, the majority of LVAD implants in occurred in VAD/Txp centers. VAD centers achieved similar cost and quality outcomes for a smaller number of less acute patients compared to VAD/Txp centers.There was no consistent relationship between increasing center volume and improved, cost, quality and mortality. These data bear direct impact on quality and volume goals for all programs and the dissemination of VAD centers into the community.
VAD vs VAD/Txp LVAD Implants UHC database 2010-2012 2010
2011
VAD/ VAD(n= 7) Txp(n= 56)
VAD(n= 8)
VAD/ Txp(n= 57)
VAD(n= 8)
VAD/ Txp(n= 58)
Average LVAD Implants (SD)
2.0(1.1)
24.1 (13.9)
3.9(2.6)
27.5(13.5)
6.8(3.0)
28.5(13.0)
LOS Index
0.52
1.01
0.95
0.93
0.83
0.88
Mortality Index
3.59
1.25
1.91
0.93
1.88
0.94
Direct Cost Index 0.64
0.95
0.87
0.98
0.86
0.99
Readmission Index
1.00
1.22
0.99
1.17
0.99
0.33
2012