Abstract | November 17, 2023
Association of Psychosocial Risk with Readmission in Left Ventricular Assist Device Patients
Learning Objectives
- Describe the differential impact of psychosocial risk factors on long-term post-implant outcomes.
- Identify the most common causes of hospital readmission for patients on left ventricular assist device support.
- Upon completion of this lecture, learners should be better prepared to suggest support systems that might help improve outcomes for heart transplant patients on device support.
Background
Advanced heart failure therapies such as Left Ventricular Assist Device (LVAD) implantation require intensive follow-up, outpatient management, and social support. At-risk populations historically have a heightened risk of adverse post-implant outcomes. We sought to characterize the burden of such risks on readmission at a major LVAD implanting center in Georgia.
Methods
A retrospective chart review was conducted of all patients with an LVAD readmitted at Emory University Hospital between January 2021 to June 2022. Baseline patient characteristics included age, sex, ethnicity, zip code, primary expected payer, type of implanted device, cardiomyopathy etiology, and psychosocial risk factors.
Results
60 patients were readmitted at least once between January 2021 to June 2022 of the 195 LVAD patients being followed during this time (31%). Mean age was 52.6 +/- 14 years (80% male). Patients were classified as high (48.3%) or low-readmission based on a median split of 4.5 readmissions (mean, 5.4) within the 18-month timeframe. Implanted devices included Heartware (31.6%), Heartmate II (5%), and Heartmate III (63.4%) as either bridge to consideration (50%), destination therapy (36.7%), or bridge-to-transplant (13.3%). Majority of patients identified as Black/African-American (70%).
At time of readmission, patients had no insurance (63.3%), Medicare (16.7%), Medicaid (1.7%), or commercial insurance (18.3%). 14 (23%) were classified as “low-readmission” and living > 50 miles away. Among 270 readmissions events, 63 (23%) had cardiac causes, most commonly being decompensated heart failure followed by arrhythmias. Of the remaining noncardiac causes, infection was the most common (33%), with 14% being device-related. Bleeding amounted to 12% (50% Heartware, 50% Heartmate 3), with 5% from gastrointestinal origin. Among “high readmission” patients, 17 (57%) were uninsured, and 21 (72%) had one or more psychosocial risk factors (including limited social support, limited cognition, substance abuse, severe psychiatric disease, and repeated noncompliance), compared to the 6% classified as “low readmission”.
Conclusion
One in every three LVAD patients readmitted for any cause had at least one psychosocial risk factor, with 91% of those patients qualifying as “high readmission”. Though descriptive, these findings demonstrate a need to further investigate a potentially underreported number of complications in certain post-implant cohorts, as well as potentially contributing psychosocial variables.
References and Resources
- DeFilippis EM, Breathett K, Donald EM, Nakagawa S, Takeda K, Takayama H, et al. Psychosocial Risk and Its Association With Outcomes in Continuous-Flow Left Ventricular Assist Device Patients. Circulation: Heart Failure. 2020;13(9):e006910.
- Agrawal S, Garg L, Shah M, Agarwal M, Patel B, Singh A, et al. Thirty-Day Readmissions After Left Ventricular Assist Device Implantation in the United States. Circulation: Heart Failure. 2018;11(3):e004628.
