Author + information
- Received September 24, 2013
- Revision received December 9, 2013
- Accepted December 11, 2013
- Published online April 15, 2014.
- Prateeti Khazanie, MD, MPH∗,†,
- Bradley G. Hammill, MS∗,
- Chetan B. Patel, MD∗,†,
- Zubin J. Eapen, MD∗,†,
- Eric D. Peterson, MD, MPH∗,†,
- Joseph G. Rogers, MD∗,†,
- Carmelo A. Milano, MD∗,†,
- Lesley H. Curtis, PhD∗,† and
- Adrian F. Hernandez, MD, MHS∗,†∗ ()
- ∗Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- †Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- ↵∗Reprint requests and correspondence:
Dr. Adrian F. Hernandez, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715.
Objectives This study sought to examine trends in mortality, readmission, and costs among Medicare beneficiaries receiving ventricular assist devices (VADs) and associations between hospital-level procedure volume and outcomes.
Background VADs are an option for patients with advanced heart failure, but temporal changes in outcomes and associations between facility-level volume and outcomes are poorly understood.
Methods This is a population-based, retrospective cohort study of all fee-for-service Medicare beneficiaries with heart failure who received an implantable VAD between 2006 and 2011. We used Cox proportional hazards models to examine temporal changes in mortality, readmission, and hospital-level procedure volume.
Results Among 2,507 patients who received a VAD at 103 centers during the study period, the in-hospital mortality decreased from 30% to 10% (p < 0.001), the 1-year mortality decreased from 42% to 26% (p < 0.001), and the all-cause readmission was frequent (82% and 81%; p = 0.70). After covariate adjustment, in-hospital and 1-year mortality decreased (p < 0.001 for both), but the all-cause readmission did not change (p = 0.82). Hospitals with a low procedure volume had higher risks of in-hospital mortality (risk ratio: 1.72; 95% confidence interval [CI]: 1.28 to 2.33) and 1-year mortality (risk ratio: 1.55; 95% CI: 1.24 to 1.93) than high-volume hospitals. Procedure volume was not associated with risk of readmission. The greatest cost was from the index hospitalization and remained unchanged ($204,020 in 2006 and $201,026 in 2011; p = 0.21).
Conclusions Short- and long-term mortality after VAD implantation among Medicare beneficiaries improved, but readmission remained similar over time. A higher volume of VAD implants was associated with lower risk of mortality but not readmission. Costs to Medicare have not changed in recent years.
This project was supported in part by grant number U19HS021092 from the Agency for Healthcare Research and Quality. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Dr. Rogers is a consultant to Thoratec Corporation and has served as a principal investigator in the HeartWare ENDURANCE Trial. Dr. Milano is a consultant to Thoratec Corporation and HeartWare Inc. Dr. Patel is a consultant to Thoratec Corporation and HeartWare Inc. Dr. Eapen is a consultant to Novartis and Janssen Pharmaceuticals, Inc. Dr. Peterson has research grants from Eli Lilly and Company and Janssen Pharmaceuticals; and is a consultant for Boehringer Ingelheim Janssen Pharmaceuticals, Inc. Dr. Curtis has received research grants from GE Healthcare, Janssen Pharmaceuticals, Inc. and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 24, 2013.
- Revision received December 9, 2013.
- Accepted December 11, 2013.
- American College of Cardiology Foundation