Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study
Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study
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DOI：
10.14503/thij-14-4971
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发表时间：
2015-10-01
影响因子：
0.9
通讯作者：
Meyers, Deborah E.
中科院分区：
文献类型：
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作者：
Hernandez, Ruben E.;Singh, Steve K.;Meyers, Deborah E.
左心室辅助装置（LVAD）治疗可改善难治性晚期心力衰竭患者的生存、血液动力学状态和终末器官灌注。再入院是衡量LVAD支持护理强度的重要指标。我们分析了2008年4月至2012年6月期间接受Heart Mate II型LVAD的148例再入院患者（平均年龄53.6±12.7岁，83%为男性）。患者有严重的心力衰竭；60.1%在机械辅助循环支持1级或2级机构间注册。所有患者至少观察12个月，再入院分为计划内和计划外。描述性和多变量回归分析用于确定意外再入院的预测因素。27例（18.2%）患者无再入院或69例计划再入院，121例（81.8%）患者有460例计划外再入院。lvad相关的再入院原因包括出血、血栓形成和抗凝（n=103; 49.1%）、泵相关感染（n=60; 28.6%）和神经系统事件（n=28; 13.3%）。再入院率为2.1 /患者年，非计划再入院是由于合并症和潜在心脏病（54.3%）或lvad相关原因（45.7%）。在非计划再入院率方面，桥接移植患者与目的地治疗患者无显著差异。非计划再入院与糖尿病相关（优势比[OR]=3.3； P=0.04），与住所到医院的距离较短相关（OR=0.998； P=0.046）。因左室辅助功能相关的后遗症和持续的合并症而意外入院的情况很常见。糖尿病和住所到医院的距离较短是再入院的重要预测因素。我们预计，改善合并症的管理和抗凝治疗将减少未来LVAD患者的意外再入院。
Left ventricular assist device (LVAD) therapy improves survival, hemodynamic status, and end-organ perfusion in patients with refractory advanced heart failure. Hospital readmission is an important measure of the intensity of LVAD support care.We analyzed readmissions of 148 patients (mean age, 53.6 +/- 12.7 yr; 83% male) who received a Heart Mate II LVAD from April 2008 through June 2012. The patients had severe heart failure; 60.1% were in Interagency Registry for Mechanically Assisted Circulatory Support class 1 or 2. All patients were observed for at least 12 months, and readmissions were classified as planned or unplanned. Descriptive and multivariate regression analyses were used to identify predictors of unplanned readmission.Twenty-seven patients (18.2%) had no readmissions or 69 planned readmissions, and 121 patients (81.8%) had 460 unplanned readmissions. The LVAD-related readmissions were for bleeding, thrombosis, and anticoagulation (n=103; 49.1%), pump-related infections (n=60; 28.6%), and neurologic events (n=28; 13.3%). The readmission rate was 2.1 per patient-year Unplanned readmissions were for comorbidities and underlying cardiac disease (54.3%) or LVAD-related causes (45.7%). In the unplanned-readmission rate, there was no significant difference between bridge-to-transplantation and destination-therapy patients. Unplanned readmissions were associated with diabetes mellitus (odds ratio [OR]=3.3; P=0.04) and with shorter mileage from residence to hospital (OR=0.998; P=0.046).Unplanned admissions for LVAD-related sequelae and ongoing comorbidities were common. Diabetes mellitus and shorter distance from residence to hospital were significant predictors of readmission. We project that improved management of comorbidities and of anticoagulation therapy will reduce unplanned readmissions of LVAD patients in the future.