Abstract 12237: All-Cause and Cause-Specific 30-day Readmission After Left Ventricular Assist Device Implantation: Comparing the HeartMate 3 vs Pre-HeartMate 3 Eras

Introduction: In recent years, the HeartMate 3 (HM3) has become the most commonly implanted left ventricular assist device (LVAD) for patients with end-stage HF in the United States. We assessed 30-day readmission rates and leading causes of readmission for patients newly receiving an LVAD in the pre-HM3 era compared to the HM3 era.

Methods: Using the Nationwide Readmission Database (NRD), all adult admissions (age ≥18) with LVAD implantation from October 2015 - December 2020 were identified. Admissions were excluded if the patient had: died while inpatient, missing data for age, sex, or mortality, transferred to another acute care facility or December admission. Multivariable Cox regression analysis with all-cause and cause-specific readmission within 30 days as the ‘failure event’ and time from index hospitalization discharge to failure event as the ‘time to failure event’ was analyzed. Based on the timing of initial FDA approval of HM3, the study period was divided into two eras: 2015-2017 was defined as the pre-HM3 era and 2019-2020 as the HM3 era. The year 2018 was deemed the transition period and excluded from the analysis.

Results: Among 13,867 hospitalizations for LVAD implantations, 57.6% of index hospitalizations were during the pre-HM3 era (mean age= 56 years, men= 77.2%), and 42.4% were during the HM3 era (mean age= 56 years, men= 76.6%). Hazards of 30-day all-cause readmissions were similar in the two eras (Figure 1 Panel A) . LVAD implantation in the HM3 era was associated with lower risks of 30-day readmission with a gastrointestinal (GI) bleed or pump thrombosis and a higher risk of 30-day readmission with an acute kidney injury (AKI) compared to the pre-HM3 era ( Figure 1 Panel B).

Conclusion: There was no significant difference in risk of 30-day all-cause readmission after LVAD implantation in the HM 3 and Pre-HM 3 eras. However, implant in the HM3 era was associated with lower risk of readmission with GI bleed and pump thrombosis and higher risk of readmission with AKI.