Abstract 19522: Trends and Outcomes in Mechanical Circulatory Support Among Medicare Beneficiaries
Background: Mechanical circulatory support (MCS) has emerged as a growing technology for patients with advanced heart failure, but diffusion and temporal trends of outcomes of this technology across centers is poorly understood.
Methods: Using 2006-2010 Medicare inpatient claims, we identified all fee-for-service beneficiaries who received an implantable MCS device. Patients were excluded if they had major cardiac surgery or non-implantable MCS device within 30d prior to implant. Outcomes of interest were in-hospital mortality and, among those discharged alive, 30d and 1yr post-discharge mortality, transplant, and readmission. We also calculated the cumulative number of readmissions and inpatient days following discharge. Death and transplant were treated as competing risks for each other and for all other post-discharge outcomes.
Results: We identified 1835 patients who received an MCS device. Annual implant volume increased from 176 in 2006 to 661 in 2010. Demographic characteristics of those receiving a device were consistent over time--mean age 59 years, 81% men, and 72% white. Elective admissions for an MCS increased over time (26% to 40%). Volume of cases per center varied but overall increased over time (Figure). In-hospital mortality decreased over time (30% to 12%, p<.001). There was a trend towards decreased 30-d readmissions with 32.5% in 2006 and 26.7% in 2010 (p=0.07). Among the 1549 patients discharged alive, observed post-discharge outcomes at 30d and 1yr were: post-discharge mortality 2.1%, 19.2%; heart transplant 2.3%, 29.5%; all-cause readmission 27.4%, 83.0%; cardiovascular readmission 11.4%, 48.8%; no. of all-cause readmissions 0.31, 1.98; and no. of inpatient days 3.2, 17.6, respectively.
Conclusions: The volume overall of MCS and proportion of elective MCS implants has increased over time. Readmission and mortality outcomes have generally improved over time as implant volume has increased and the patient profiles have changed.
- © 2012 by American Heart Association, Inc.