Mortality lower with VADs, but readmissions still high

Ventricular assist devices (VADs) may lower the risk of mortality, but not readmission, according to a study published online Jan. 29 in the Journal of the American College of Cardiology.

Prateeti Khazanie, MD, MPH, and colleagues at Duke University School of Medicine in Durham, N.C., identified Medicare beneficiaries hospitalized for VAD implantation with a diagnosis of heart failure or cardiogenic shock between 2006 and 2011.

“We sought to describe trends in short-term and long-term mortality, readmission, volume-outcome relationships, and costs among all fee-for-service Medicare beneficiaries receiving VADs and between 2006 and 2011,” the authors wrote.

They identified 2,507 patients who underwent VAD implantation at 103 U.S. facilities. Between 2006 and 2011, mortality decreased from 30 percent to 10 percent and one-year mortality decreased from 42 percent to 26 percent. Readmissions were common throughout the study period—82 percent and 81 percent.

After statistical adjustment, in-hospital and one-year mortality declined, but readmissions for any reason did not change. Hospitals with low VAD implantation volume had higher in-hospital and one-year mortality risks (risk ratio 1.72 and 1.55) compared with high-volume hospitals, but the volume of procedures was not linked to readmission risk.

The highest cost came from the index hospitalization and remained the same throughout the study period—$204,020 in 2006 and $201,026 in 2011.

The authors argued that their study suggests a closer look at reimbursement related to facility’s procedure volume.

"[E]xamination of the relationship between center experience and outcomes may be useful as accreditation agencies and payers refine criteria for implantation sites,” they wrote.