Abstract 17522: Home Monitoring is Associated With Fewer Hospital Readmissions Following Left Ventricular Assist Device Implantation
Introduction: Hospital readmission is common following implantation of a continuous flow left ventricular assist device (LVAD).
Hypothesis: Frequent home monitoring (HM) of blood pressure (BP), weights, LVAD parameters and international normalized ratio (INR) may decrease hospital readmissions compared to standard of care (SOC).
Methods: All consecutive discharged patients (pts) from 2011-2016 implanted with an LVAD at our institution were analyzed. The Alere Monitor (Waltham, MA) provided daily weight, BP and LVAD parameters, and biweekly INR. SOC pts measured INR every 1-2 weeks, BP every 2-3 months, and reported weight and LVAD parameters when outside of a predetermined range. Hospital admissions were assessed by retrospective blinded chart review. Kaplan-Meier and the Fine-Gray model estimated incidence and competing risks regression.
Results: Of 98 LVAD pts, 42 used HM. HM and SOC pts were similar (56 ± 14 years, 15% female, 54% white, 35% destination therapy, 44% INTERMACS profile 1 or 2, anticoagulation 94%, aspirin 74%). More SOC pts had ischemic cardiomyopathy (55% vs. 33%, p=0.03) and received an axial LVAD (64% vs. 26%, p<0.001). Over 96 pts-years follow-up, there were 98 all-cause readmissions among 54 pts that occurred at median 2.2 months, with rate 1.16 first-admissions/pts-year [95% confidence interval (CI) 0.89-1.51]. By 1-year, 77% (CI 61-91%) of SOC and 53% (CI 37-72%) of HM pts were readmitted, p=0.011. After accounting for competing death and transplantation, the hazard ratio (HR) for readmission for HM was 0.64 (CI 0.37-1.12, p=0.11). Furthermore, 41 pts were admitted at a median of 2.2 months for LVAD-associated preventable complications (heart failure, bleeding, stroke, arrhythmia, pump thrombosis, hypertension) at a rate of 0.73 first-admissions/pts-year (CI 0.54-0.99), with 69% (CI 52-84%) of SOC and 30% (CI 17-49%) of HM pts admitted by 1-year, p<0.001. Accounting for competing events, HR for readmission for HM was 0.41 (CI 0.21-0.80, p=0.010), and after further adjustment HR was 0.41 (CI 0.19-0.86, p=0.019).
Conclusions: Frequent HM of BP, weight, VAD parameters, and INR was associated with decreased risk for hospital readmission in this single institution LVAD cohort. This finding merits replication in a larger dataset.
Author Disclosures: M.A. Psotka: None. J. Svetlichnaya: None. M. Kassemos: None. K. Kobasic: None. K. McClure: None. S. Sharma: None. Y. Nam: None. V.N. Selby: None. M. Janmohamed: None. T. De Marco: None. G. Wieselthaler: None. L. Klein: None.
- © 2016 by American Heart Association, Inc.