Thirty-Day Readmissions After Left Ventricular Assist Device Implantation in the United States Insights From the Nationwide Readmissions Database
Thirty-Day Readmissions After Left Ventricular Assist Device Implantation in the United States Insights From the Nationwide Readmissions Database
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DOI：
10.1161/circheartfailure.117.004628
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发表时间：
2018-03-01
影响因子：
9.7
通讯作者：
Kapur, Navin K.
中科院分区：
文献类型：
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作者：
Agrawal, Sahil;Garg, Lohit;Kapur, Navin K.
背景：早期再入院显著增加心力衰竭相关的发病率，并对生活质量产生负面影响。左心室辅助装置（LVAD）相关的30天再入院的数据是稀缺的，仅限于小型study.METHODS和结果：患者接受LVAD植入2013年1月至2014年11月谁生存的索引住院在全国再入院数据库中确定。我们分析了30天再入院的发生率、预测因素、原因和费用。在2510名LVAD接受者中，788名（31%）在30天内再次入院。首次住院时间>= 31天（风险比[HR]，1.26; 95%置信区间[CI]，1.07-1.50）和女性（HR，1.19; 95%CI，1.01-1.42）与30天再入院的风险较高相关，而私人保险（HR，0.83; 95% CI，0.70-0.99）、LVAD前使用短期机械循环支持（HR，0.53; 95% CI，0.29-0.98）和出院至短期医院（HR，0.41; CI，0.21-0.78）与较低风险相关。心脏原因占再入院的23.8%：心力衰竭（13.4%）和心律失常（8.1%）。非心血管原因占再入院的76.2%：感染（30.2%）、出血（17.6%）和器械相关原因（8.2%）。平均住院时间为10.7天（中位数为6天），平均住院费用为34948 +/-2457美元。结论：即使在当代，LVAD植入后早期再入院也很常见。需要植入前识别高风险患者，并使用多学科方法进行方案驱动的随访，以减少再入院并改善结局。
BACKGROUND: Early readmissions contribute significantly to heart failure-related morbidity and negatively affect quality of life. Data on left ventricular assist device (LVAD)-related 30-day readmissions are scarce and limited to small studies.METHODS AND RESULTS: Patients undergoing LVAD implantation between January 2013 and November 2014 who survived the index hospitalization were identified in the Nationwide Readmissions Database. We analyzed the incidence, predictors, causes, and costs of 30-day readmissions. Of 2510 LVAD recipients, 788 (31%) were readmitted within 30 days. Length of index hospitalization >= 31 days (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.07-1.50) and female sex (HR, 1.19; 95% CI, 1.01-1.42) were associated with a higher risk of 30-day readmission, whereas private insurance (HR, 0.83; 95% CI, 0.70-0.99), pre-LVAD use of short-term mechanical circulatory support (HR, 0.53; 95% CI, 0.29-0.98), and discharge to a short-term hospital facility (HR, 0.41; CI, 0.21-0.78) were associated with a lower risk. Cardiac causes accounted for 23.8% of readmissions: heart failure (13.4%) and arrhythmias (8.1%). Noncardiovascular causes accounted for 76.2% of readmissions: infection (30.2%), bleeding (17.6%), and devicerelated causes (8.2%). Mean length of stay for readmission was 10.7 days (median, 6 days), and average hospital cost per readmission was $34948 +/- 2457.CONCLUSIONS: Early readmissions are frequent after LVAD implantation even in contemporary times. Preimplant identification of high-risk patients, and a protocol-driven follow-up using a multidisciplinary approach will be needed to reduce readmissions and improve outcomes.