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Sherazi S, Alexis JD, McNitt S, Polonsky B, Shah S, Younis A, Kutyifa V, Vidula H, Gosev I, Goldenberg I. Racial differences in clinical characteristics and readmission burden among patients with a left ventricular-assist device. Artif Organs 2023; 47:1242-1249. [PMID: 36820756 DOI: 10.1111/aor.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND There are limited data regarding racial disparities in outcomes after left ventricular assist device (LVAD) implantation. The purpose of this study was to compare clinical characteristics and the burden of readmissions by race among patients with LVAD. METHODS The study population included 461 patients implanted with LVADs at the University of Rochester Medical Center, NY from May 2008 to March 2020. Patients were stratified by race as White patients (N = 396 [86%]) and Black patients (N = 65 [14%]). The Anderson-Gill recurrent regression analysis was used to assess the independent association between race and the total number of admissions after LVAD implant during an average follow-up of 2.45 ± 2.30 years. RESULTS Black patients displayed significant differences in baseline clinical characteristics compared to White patients, including a younger age, a lower frequency of ischemic etiology, and a higher baseline serum creatinine. Black patients had a significantly higher burden of readmissions after LVAD implantation as compared with White patients 10 versus 7 (average number of hospitalizations per patient at 5 years of follow-up, respectively) translated into a significant 39% increased risk of recurrent readmissions after multivariate adjustment (Hazard ratio 1.39, 95% CI; 1.07-1.82, p 0.013). CONCLUSION Black LVAD patients experience an increased burden of readmissions compared with White patients, after adjustment for baseline differences in demographics and clinical characteristics. Future studies should assess the underlying mechanisms for this increased risk including the effect of social determinants of health on the risk of readmissions in LVAD recipients.
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Affiliation(s)
- Saadia Sherazi
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jeffrey D Alexis
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Suhaib Shah
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Arwa Younis
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Himabindu Vidula
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Igor Gosev
- Division of Cardiothoracic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Wernhart S, Papathanasiou M, Jakstaite A, Hoffmann J, Schmack B, Hedderich J, Ruhparwar A, Rassaf T, Luedike P. Exercise oscillatory ventilation in patients with advanced heart failure with and without left ventricular assist device. Artif Organs 2023; 47:168-179. [PMID: 36102469 DOI: 10.1111/aor.14398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/25/2022] [Accepted: 08/26/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV), indicating pathological fluctuations on pulmonary arterial pressure, is associated with mortality in patients with heart failure (HF). Whether left ventricular assist device (LVAD)-induced ventricular unloading can reverse EOV and may prevent short-term rehospitalization has not been investigated. METHODS We performed a retrospective single-center in- and outpatient analysis of patients with (n = 20, LVAD) and without (n = 27, HF) circulatory support and reduced ejection fraction (EF, 22.8 ± 7.9%). The association of cardiopulmonary exercise testing (CPET) variables and 3 months-rehospitalization (3MR) as a primary outcome was analyzed. Furthermore, CPET variables were compared regarding the presence of EOV (+/-). RESULTS Lower VO2peak (11.6 ± 4.9 ml/kg/min vs. 14.4 ± 4.3 ml/kg/min, p = 0.039), lower increase of PETCO2 (CI = 0.049-1.127; p = 0.068), and higher VE/VCO2 (43.8 ± 9.5 vs. 38.3 ± 10.6; p = 0.069) were associated with 3MR. Flattening of O2 pulse (CI = 0.139-2.379; p = 0.487) had no impact on 3MR. EOV was present in 59.5% (n = 28/47) of patients, without a significant difference between LVAD and HF patients (p = 0.959). Patients with HF/EOV+ demonstrated significantly lower VO2peak compared with HF/EOV- (p = 0.039). LVAD/EOV+ displayed significantly lower EF (p = 0.004) and fewer aortic valve opening than LVAD/EOV- (p = 0.027). CONCLUSIONS Lower VO2peak , but not EOV, was associated with 3MR. EOV occurred at a similar rate in LVAD and HF patients, which may illustrate insufficient unloading during exercise in chronic LVAD therapy and may contribute to the limited exercise capacity following LVAD implantation. Simultaneous CPET and right heart catheterization studies are needed to elucidate whether EOV may serve as a non-invasive predictor of insufficient LV unloading necessitating LVAD reprograming.
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Affiliation(s)
- Simon Wernhart
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Aiste Jakstaite
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Julia Hoffmann
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Clinic of Thoracic and Cardiovascular Surgery, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jürgen Hedderich
- Medistat- Biomedical Statistics, Medistat GmbH, Kronshagen, Germany
| | - Arjang Ruhparwar
- Clinic of Thoracic and Cardiovascular Surgery, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Yen HY, Chi MJ, Huang HY. Effects of discharge planning services and unplanned readmissions on post-hospital mortality in older patients: a time-varying survival analysis. Int J Nurs Stud 2022; 128:104175. [DOI: 10.1016/j.ijnurstu.2022.104175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 12/11/2022]
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Pavol MA, Boehme AK, Yuzefpolskaya M, Maurer MS, Casida J, Festa JR, Ibeh C, Willey JZ. Cognition predicts days-alive-out-of-hospital after LVAD implantation. Int J Artif Organs 2021; 44:952-955. [PMID: 34011184 DOI: 10.1177/03913988211018484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cognition influences hospitalization rates for a variety of patient groups but this association has not been examined in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation. We used cognition to predict days-alive-out-of-hospital (DAOH) in patients after LVAD surgery. METHODS We retrospectively identified 59 HF patients with cognitive assessment prior to LVAD. Cognitive tests of attention, memory, language, and visual motor speed were averaged into one score. DAOH was converted to a percentage based on total days from LVAD surgery to either heart transplant or 900 days post-LVAD. Variables significantly associated with DAOH in univariate analyses were included in a linear regression model to predict DAOH. RESULTS A linear regression model including LVAD type (continuous or pulsatile flow) and cognition significantly predicted DAOH (F(2,54) = 6.44, p = 0.003, R2 = .19). Inspection of each variable revealed that cognition was a significant predictor in the model (β = .11, SE = .04, p = 0.007) but LVAD type was not (p = 0.08). CONCLUSIONS Cognitive performance assessed prior to LVAD implantation predicted how much time patients spent out of the hospital following surgery. Further studies are warranted to identify the impact of pre-LVAD cognition on post-LVAD hospitalization.
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Affiliation(s)
- Marykay A Pavol
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Division of Neurology Clinical Outcomes Research and Population Science, Columbia University Irving Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Cardiology Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Mathew S Maurer
- Department of Medicine, Cardiology Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesus Casida
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Joanne R Festa
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chinwe Ibeh
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Joshua Z Willey
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
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Kim YK, Balcetis N, Novitch R, Oh-park M. Risk factors of readmission to acute care hospital among individuals with heart failure and left ventricular assist device (LVAD) at inpatient rehabilitation setting (STROBE compliant article). Medicine (Baltimore) 2020; 99:e23618. [PMID: 33350737 PMCID: PMC7769323 DOI: 10.1097/md.0000000000023618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
In post-acute care hospital setting, the heart failure (HF) individuals with left ventricular assist device (LVAD) have about 30% of transfer to acute care hospitals which requires readmission. There is relative increase in cost and mortality due to the readmission.The goal of this study is to identify possible risk factors at Inpatient Rehabilitation Unit (IRU) to decrease the rate of readmission to acute care hospitals.This study is retrospective study at the Inpatient Rehabilitation Unit (IRU)Twenty one individuals with HF and LVAD were admitted to IRU. We determined 2 subgroups. One is the readmission group (Readmission) and the other is the control group (Control). Readmission (n = 6) is the individuals who were transferred to acute care hospital, and Control (n = 15) is the individuals who were discharged.To compare Readmission group with Control group and evaluate demographic, laboratory, and functional outcome parameters. Main Outcome Measures are Body Mass Index (BMI), International Normalized Ratio (INR), and Functional independence measure (FIM).At admission, INR in Readmission group was 3.4 ± 1.2 and in Control group was 2.2 ± 0.5 with a statistically significant p value (P = .004) and FIM score in Readmission group was 81.2 ± 15.9 and in Control group was 96.3 ± 11.5 with a statistically significant p value (P = .023).The study showed the individuals with HF and LVAD at IRU had high INR and low FIM which may be the cause for readmission and need more attentive care. This data can help identify the factors causing readmission and help reduce the rate of readmission. Further evaluation is necessary to determine the cause for readmission.
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Affiliation(s)
- Yong Kyun Kim
- Department of Rehabilitation, Myongji Hospital, Hanyang University School of Medicine, Gyeonggi, Korea
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