Author + information
Background: The Centers for Medicare and Medicaid Services penalizes hospitals for excess 30-day readmissions and mortality after acute myocardial infarction (AMI) or heart failure (HF) hospitalization. There is concern as to whether Centers for Medicare and Medicaid Services should exclude hospitalizations when a left ventricular assist device (LVAD) is used. We sought to examine patient and hospital-level outcomes for AMI and HF based on LVAD utilization.
Methods: We used July 2010 to June 2013 data for Medicare fee-for-service beneficiaries and identified LVAD use and hospitalizations for AMI and HF consistent with methods for public reporting. Hospital-level 30-day risk standardized mortality (RSMR) and readmission rates (RSRR) were calculated before and after excluding LVAD patients.
Results: The cohort included 506,543 patients for AMI mortality, 526,309 for AMI readmission, 1,015,335 for HF mortality, and 1,254,124 for HF readmission. LVADs were used in 1,166 (0.23%) patients for AMI mortality, 1,016 (0.19%) for AMI readmission, 789 (0.08%) for HF mortality, and 931 (0.07%) for HF readmission. LVADs used for AMI were primarily for acute hemodynamic support (i.e. Impella) while those for HF were for more chronic support (i.e. HeartMate). Despite marked differences in patient-level outcomes, there were no significant differences in hospital-level RSMR and RSRR before and after excluding LVADs (Table).
Conclusions: Public reporting of hospital performance is unaffected by LVAD patients.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure and Cardiomyopathies: What Next When All Else Is Failing?
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1248-248
- 2017 American College of Cardiology Foundation