Survival and Readmission Burden in Advanced Heart Failure Patients Managed With Ventricular Assist Device Versus Continued Medical Therapy.

As questions remain about the risk-benefit of left ventricular assist device (LVAD) therapy, we evaluated the association between LVAD versus medical therapy for the competing risk of all-cause mortality and all-cause readmission. Among consecutive patients evaluated for advanced heart failure (HF) therapy, 260 were referred for LVAD implantation and 292 continued medical therapy in this retrospective, observational database study. At 2 years, all-cause mortality was significantly higher among medically managed patients versus LVAD recipients (37% vs. 25%, p = 0.014). Separation in event rates appeared within 3 months and was sustained throughout follow-up. The cumulative incidence rate of all-cause readmissions at 2 years was higher among LVAD recipients (78% vs. 40%, p < 0.001). In multivariate analysis, compared with medical therapy, LVAD therapy was associated with a significant 35% lower risk of death (p = 0.005), driven by a 57% reduction in the risk of death within the first 3 months (p < 0.001), and a 2.8-fold increased risk of readmission. Among medically managed patients, lower baseline hemoglobin and blood pressure, older age, and increased creatinine were predictors of death. In conclusion, among patients with advanced HF, LVAD therapy was associated with pronounced survival benefit, but a higher 2-year readmission rate compared with medical management.