Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in Gastrointestinal Bleeding

Feng Li, Alice Hinton, Alan Chen, Nishaki K. Mehta, Samer Eldika, Cheng Zhang, Hisham Hussan, Darwin L. Conwell, Somashekar G. Krishna

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Left ventricular assist devices (LVADs) are being utilized for management of end-stage heart failure and require systemic anticoagulation. Gastrointestinal bleeding (GIB) is one of the most common adverse events following LVAD implantation. Aim: To investigate the impact of continuous-flow (CF) LVAD implants on outcomes of patients admitted with GIB. Methods: This is a cross-sectional study utilizing the Nationwide Inpatient Sample in the CF-LVAD era from 2010 to 2012. All adult admissions with a primary diagnosis of GIB were included. Among hospitalizations with GIB, patients with (cases) and without (controls) CF-LVAD implants were compared using univariate and multivariate analyses. The main outcome measurements were in-hospital mortality, length of stay, and hospitalization costs. Results: Among 1,002,299 hospitalizations for GIB, 1112 (0.11%) patients had CF-LVADs. Bleeding angiodysplasia accounted for a majority of GIB in CF-LVAD patients (35.4% of 1112). Multivariate analysis adjusting for demographic, hospital and etiological differences, site of GIB, and patient comorbidities revealed that CF-LVADs were not adversely associated with mortality in GIB (OR 0.53, 95% CI 0.07–4.15). However, CF-LVADs independently accounted for prolonged hospitalization (3.5 days, 95% CI 2.6–4.6) and higher hospital charges ($37,032, 95% CI $7991–$66,074). Conclusions: In patients admitted with GIB, CF-LVAD implantation accounts for higher healthcare utilization, but is not adversely associated with mortality despite therapeutic anticoagulation, increased comorbidities, and comparatively delayed endoscopy. These findings are relevant as CF-LVADs are the dominant type of LVAD and are associated with increased risk of GIB compared to their predecessors.

Original languageEnglish
Pages (from-to)150-160
Number of pages11
JournalDigestive Diseases and Sciences
Volume62
Issue number1
DOIs
StatePublished - Jan 1 2017

Bibliographical note

Publisher Copyright:
© 2016, Springer Science+Business Media New York.

Keywords

  • Cardiovascular disease
  • Endoscopy
  • Gastrointestinal bleeding
  • Heart failure
  • Left ventricular assist devices

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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