Factors Associated With Readmissions Following Left Ventricular Assist Device Implantation

Abstract

Introduction

While left ventricular device implantation has been shown to improve both survival and quality of life in patients with end stage heart failure, these patients have a high rate of readmissions to the hospital. The incidence and factors associated with readmission are poorly characterized in the destination therapy population.

Methods

All patients who underwent HeartMate III left ventricular assist device therapy (LVAD) implantation at our facility from 2017 to 2023 were identified. Patients undergoing primary LVAD implantation were included. Primary outcome was readmission for any reason. Multivariable linear regression was utilized to identify predictors of readmissions.

Results

From 2017 to 2023, 151 primary LVAD implantations were performed with 12 (8.0%) perioperative moralities (defined as index implant hospitalization mortality). The 139 remaining patients suffered 456 separate readmissions with a median follow-up of 590 (303-1002) ds and a total follow-up of 270.7 patient-ys for a rate of 1.7 readmissions per patient-y. The most common cause of readmission was heart failure exacerbation (27.0%), major infection (17.8%), and major bleeding (13.6%). Patients who were readmitted within 6 mos were more likely to have New York Heart Association class III or IV symptoms compared to those who had not been readmitted 39.1% versus 11.8% versus 15%, P = 0.0008. On multivariable linear regression, increasing body mass index (P = 0.02), increased preoperative bilirubin (P = 0.04), and increased follow-up time (P < 0.01) were predictive of the need for readmissions.

Conclusions

Following LVAD implantation, readmissions within 6 mos of surgery are associated with worse functional status at 6 mos and 1 y postoperatively. Increased body mass index and preoperative bilirubin were associated with more frequent readmissions.