Short-Term Care Burden After Left Ventricular Assist Device Implantation and Heart Transplant in the United States.

backgroundHeart transplant (HT) and left ventricular assist devices (LVADs) are treatment options for advanced heart failure refractory to standard therapy. Historically, LVADs have been used as either destination therapy or a bridge to transplant. However, recent changes to the organ allocation system have deprioritized patients on LVADs as transplant recipients, leading to divisive views on the role of an LVAD. The comparative short-term care burden with each modality remains unclear.

methodsWe aimed to describe and compare characteristics, outcomes, and cost burden during index hospitalizations and 30-day and 90-day readmissions associated with HTs and durable LVADs from a large, national administrative database. A review of the Nationwide Readmissions Database from 2018 to 2021 describing a cohort identified using

resultsWe identified 27 308 index hospital admissions; 52.4% received LVADs, and the remainder received HTs. Compared with HT recipients, LVAD recipients were older and more likely male, of lower socioeconomic status, had longer index hospital stays, and had more expensive index hospitalizations. A higher proportion of LVAD recipients required rehospitalization in 30 days. The most frequent causes of rehospitalization in the LVAD group at both 30 and 90 days were heart failure, device complications, and gastrointestinal bleeding. The most frequent causes in the HT group at 30 and 90 days were transplant complications, renal dysfunction, and sepsis (at 90 days only). Thirty- and 90-day rehospitalization costs were greater in the HT group.

conclusionsBoth LVAD and HT had comparable burdens on resources and short-term rehospitalization risk.