Readmission and Temporal Trends of Post-LVAD Placement Complications in Patients With End-Stage Heart Failure.

Abstract

Introduction: Approximately 5%-10% of heart failure (HF) patients progress to advanced stages. Left ventricular assist devices (LVADs) have emerged as a favored therapy for end-stage HF as destination therapy or as a bridge to heart transplantation. However, complications and provider expertise hinder their widespread use. To address this, the third-generation LVAD was introduced in late 2018 to enhance usability and reduce complications. We aimed to investigate the temporal trends in post-LVAD complications with the newest generation LVAD versus the previous version.

Methods: We utilized the 2016-2020 Nationwide Readmission Database to identify patients ≥ 18 years of age with advanced HF implanted with an LVAD. Variables were determined using the International Classification of Diseases, Tenth revision codes. We compared patients through all years individually. In addition, we created two groups based on the implant year (2016-2018 and 2019-2020). The primary outcome was 30-day readmission, while secondary outcomes were complications and mortality rates. Multivariate analyses and descriptive bivariate analyses were performed. A value of p < 0.05 was considered statistically significant.

Results: We identified 7975 patients (21.3% females), of which 17.1% (n = 1214) were readmitted within 30 days. Readmission rates were 18% (n = 778) for 2016-2018 and 16% (n = 435) for 2019-2020 (adjusted Wald test, p = 0.26). The 2019-2020 group exhibited a reduction in cardiac device complications (p = 0.024), cardiac tamponade (p = 0.009), and periprocedural circulatory complications (p = 0.014) in subgroup comparison (2016-2018 vs. 2019-2020). Despite these improvements, the mortality rate and hospital stay did not differ significantly between the two periods. No significant differences in mortality or LOS were observed between the two groups (adjusted Wald test, p > 0.05 in both).

Conclusions: Complications following LVAD placement continue to impede its broader adoption for advanced HF. Advancements in newer LVAD technology and improved provider expertise hold promise for increased utilization. Our study indicated a decline in some complications, including cardiac tamponade and cardiac device complications, including periprocedural circulatory ones, which may be attributed to newer device innovations. Further research is necessary to explore this correlation in greater depth.