Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries.
Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries.
复制标题
DOI：
10.1001/jama.2008.716
复制
发表时间：
2008-11-26
影响因子：
120.7
通讯作者：
Curtis, Lesley H.
中科院分区：
文献类型：
--
作者：
Hernandez, Adrian F.;Shea, Alisa M.;Milano, Carmelo A.;Rogers, Joseph G.;Hammill, Bradley G.;O'Connor, Christopher M.;Schulman, Kevin A.;Peterson, Eric D.;Curtis, Lesley H.
2003年，Medicare扩大了将心脏辅助装置作为终末期心力衰竭的目的地或永久性治疗的覆盖范围。人们对这些设备的长期结果和成本知之甚少。检查单独接受心脏辅助装置或心脏直视手术后接受心脏辅助装置的医疗保险受益人的急性和长期结果。分析2000年至2006年期间医疗保险和医疗补助服务中心的所有住院索赔。患者为医疗保险服务费受益者，他们在2000年2月至2006年6月期间单独接受了心脏辅助装置(n=1476)，或在之前30天内接受了心脏切开(n=1467)。装置更换、装置取出、心脏移植、再入院和死亡的累积发生率，考虑了审查和竞争风险。我们对患者进行了至少6个月的跟踪调查，并确定了与长期生存相关的独立因素。我们使用联邦医疗保险支付来计算住院总成本和医院外每天的成本。一次置入组1年生存率为51.6%(n=669)，心脏切开术后置入组1年生存率为30.8%(n=424)。在初级装置患者中，815人(55.2%)带着装置活着出院。其中450例(55.6%)在6个月内再次入院，504例(73.2%)在1年内存活。493例(33.6%)心内直视术后患者带着装置出院，其中237例(48.3%)在6个月内再次入院，355例(76.6%)在1年时存活。在2000-2005年的队列中，主要设备组患者住院护理的平均1年医疗保险支出为178 714美元(SD，142 549美元)，心脏切开术后组为111 769美元(SD，95 413美元)。在接受心脏辅助装置的医疗保险受益人中，早期死亡率、发病率和费用仍然很高。改善患者选择和降低围手术期死亡率将是改善整体预后的关键。
In 2003, Medicare expanded coverage of ventricular assist devices as destination, or permanent, therapy for end-stage heart failure. Little is known about long-term outcomes and costs associated with these devices. To examine acute and long-term outcomes of Medicare beneficiaries receiving ventricular assist devices alone or after open-heart surgery. Analysis of all inpatient claims from the Centers for Medicare & Medicaid Services for the period 2000 through 2006. Patients were Medicare fee-for-service beneficiaries who received a ventricular assist device between February 2000 and June 2006 alone (n = 1476) or after cardiotomy in the previous 30 days (n = 1467). Cumulative incidence of device replacement, device removal, heart transplantation, readmission, and death, accounting for censoring and competing risks. We followed patients for at least 6 months and identified factors independently associated with long-term survival. We used Medicare payments to calculate total inpatient costs and costs per day outside the hospital. Overall 1-year survival was 51.6% (n = 669) in the primary device group and 30.8% (n = 424) in the postcardiotomy group. Among primary device patients, 815 (55.2%) were discharged alive with a device. Of those, 450 (55.6%) were readmitted within 6 months and 504 (73.2%) were alive at 1 year. Of the 493 (33.6%) postcardiotomy patients discharged alive with a device, 237 (48.3%) were readmitted within 6 months and 355 (76.6%) were alive at 1 year. Mean 1-year Medicare payments for inpatient care for patients in the 2000–2005 cohorts were $178 714 (SD, $142 549) in the primary device group and $111 769 (SD, $95 413) in the postcardiotomy group. Among Medicare beneficiaries receiving a ventricular assist device, early mortality, morbidity, and costs remain high. Improving patient selection and reducing perioperative mortality will be critical for improving overall outcomes.
登录
查看更多内容
影响因子：
158.5
作者：
Rose, EA;Gelijns, AC;Meier, P
通讯作者：
Meier, P
影响因子：
1.9
作者：
PRENTICE, RL;KALBFLEISCH, JD;BRESLOW, NE
通讯作者：
BRESLOW, NE
影响因子：
9.7
作者：
Kirklin, James K.;Naftel, David C.
通讯作者：
Naftel, David C.
影响因子：
37.8
作者：
Lietz, Katherine;Long, James W.;Miller, Leslie W.
通讯作者：
Miller, Leslie W.
影响因子：
3.4
作者：
Esmore, Donald;Spratt, Phillip;Woodard, John
通讯作者：
Woodard, John