The Burden of Readmissions in the First Year with an LVAD: Predictors and Associated Quality of Life Outcomes

Purpose The purpose of this study is to determine pre-operative indicators associated with longer hospital stays in the first year post-LVAD implant impact on quality of life. We hypothesized that patients with more high risk features pre-implant would require longer and more frequent hospitalizations and that their quality of life with be lower post-implant. Methods We performed a retrospective analysis of LVAD patients from our institution from 2017 to 2019 who survived the initial implant hospital stay and to one year on support. Descriptive statistics and logistic regression modeling were performed with STATA 15.1. Results 95 patients were included in the study population (78% men, average age 59 years). Patients’ burden of hospitalization was analyzed two ways: 1) total number of days spent inpatient in the first year post-LVAD implant, including both the initial implant and readmissions (mean = 37.1, SD = 25.3) and 2) total days readmitted in the first year post-implant from initial discharge (mean = 14.3 days, SD = 18.1). Pre-implant BMI was higher in patients who were readmitted for more days (coefficient = 0.825, p = 0.019). Pre-implant creatinine was higher in patients who had a greater number of days readmitted (coefficient = 9.13, p = 0.023) and greater total number of days inpatient (coefficient = 11.4, p = 0.048). Patients who spent greater total time in the hospital post-implant also had lower pre-operative INTERMACS scores (coefficient = -7.37, p = 0.008). Patients also completed the EuroQoL EQ-5D at 1 year, where they were asked about their satisfaction with the outcome of their VAD surgery. Patients with higher total numbers of days inpatient during their first year post-implant reported lower satisfaction on this question (coefficient = -0.065, p = 0.004). Other components of the EuroQoL were not significantly different. Conclusion Pre-operative creatinine and INTERMACS profile are associated with higher total number of days spent in the hospital in the first year post-LVAD implant (initial implant and readmission) and higher BMI is associated with greater readmission days. There is also an association between greater number of days spent in the hospital and decreased satisfaction post-implant. This highlights the need to establish greater supports for the high risk LVAD patient populations to improve post-implant quality of life.