Outcomes among patients undergoing LVAD in Medicare fee-for-service, 2004–2011
| 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | |
|---|---|---|---|---|---|---|---|---|
| In-hospital mortality rate, n (%) | 62 (57.9) | 93 (51.4) | 56 (42.1) | 61 (33.0) | 58 (28.2) | 60 (20.3) | 85 (19.6) | 98 (16.0) |
| By age group | ||||||||
| 65–74, n (%) | 42 (51.9) | 79 (53.0) | 41 (39.0) | 41 (30.1) | 47 (27.3) | 48 (20.3) | 62 (17.8) | 76 (15.7) |
| ≥75, n (%) | 20 (76.9) | 13 (41.9) | 15 (53.6) | 19 (39.6) | 11 (33.3) | 12 (20.7) | 22 (26.2) | 20 (16.4) |
| By gender | ||||||||
| Female, n (%) | 18 (69.2) | 30 (66.7) | 11 (40.7) | 13 (40.6) | 11 (26.2) | 5 (14.3) | 11 (18.6) | 20 (21.1) |
| Male, n (%) | 44 (54.3) | 63 (46.3) | 45 (42.5) | 48 (31.4) | 47 (28.7) | 55 (21.2) | 74 (19.8) | 78 (15.1) |
| By race | ||||||||
| White, n (%) | 54 (56.3) | 83 (53.2) | 46 (41.4) | 49 (31.8) | 50 (27.5) | 50 (19.6) | 74 (19.3) | 84 (15.7) |
| Black, n (%) | 3 (50.0) | 5 (38.5) | 5 (35.7) | 6 (33.3) | 3 (20.0) | 7 (29.2) | 5 (14.7) | 6 (12.8) |
| Other*, n (%) | 5 (100.0) | 5 (41.7) | 5 (62.5) | 6 (46.2) | 5 (55.6) | 3 (18.8) | 6 (37.5) | 8 (27.6) |
| 30-day mortality rate, n (%) | 56 (52.3) | 71 (39.2) | 44 (33.1) | 50 (27.0) | 42 (20.4) | 44 (14.9) | 66 (15.2) | 55 (9.0) |
| By age group | ||||||||
| 65–74, n (%) | 38 (46.9) | 57 (38.3) | 33 (31.4) | 31 (22.8) | 32 (18.6) | 34 (14.4) | 46 (13.2) | 49 (10.1) |
| ≥75, n (%) | 18 (69.2) | 13 (41.9) | 11 (39.3) | 18 (37.5) | 10 (30.3) | 10 (17.2) | 19 (22.6) | 4 (3.3) |
| By gender | ||||||||
| Female, n (%) | 16 (61.5) | 25 (55.6) | 10 (37.0) | 14 (43.8) | 11 (26.2) | 7 (20.0) | 8 (13.6) | 12 (12.6) |
| Male, n (%) | 40 (49.4) | 46 (33.8) | 34 (32.1) | 36 (23.5) | 31 (18.9) | 37 (14.2) | 58 (15.5) | 43 (8.3) |
| By race | ||||||||
| White, n (%) | 50 (52.1) | 62 (39.7) | 36 (32.4) | 41 (26.6) | 36 (19.8) | 37 (14.5) | 58 (15.1) | 49 (9.1) |
| Black, n (%) | 2 (33.3) | 3 (23.1) | 4 (28.6) | 3 (16.7) | 3 (20.0) | 5 (20.8) | 4 (11.8) | 1 (2.1) |
| Other*, n (%) | 4 (80.0) | 6 (50.0) | 4 (50.0) | 6 (46.2) | 3 (33.3) | 2 (12.5) | 4 (25.0) | 5 (17.2) |
| 1-Year mortality rate, n (%) | 74 (69.2) | 121 (66.9) | 72 (54.1) | 93 (50.3) | 82 (39.8) | 90 (30.5) | 135 (31.2) | |
| By age group | ||||||||
| 65–74, n (%) | 52 (64.2) | 101 (67.8) | 54 (51.4) | 64 (47.1) | 63 (36.6) | 66 (28.0) | 103 (29.6) | |
| ≥75, n (%) | 22 (84.6) | 19 (61.3) | 18 (64.3) | 28 (58.3) | 19 (57.6) | 23 (39.7) | 31 (36.9) | |
| By gender | ||||||||
| Female, n (%) | 20 (76.9) | 32 (71.1) | 15 (55.6) | 20 (62.5) | 13 (31.0) | 8 (22.9) | 17 (28.8) | |
| Male, n (%) | 54 (66.7) | 89 (65.4) | 57 (53.8) | 73 (47.7) | 69 (42.1) | 82 (31.5) | 118 (31.6) | |
| By race | ||||||||
| White, n (%) | 64 (66.7) | 106 (67.9) | 61 (55.0) | 75 (48.7) | 72 (39.6) | 77 (30.2) | 121 (31.6) | |
| Black, n (%) | 5 (83.3) | 7 (53.8) | 5 (35.7) | 10 (55.6) | 5 (33.3) | 8 (33.3) | 8 (23.5) | |
| Other*, n (%) | 5 (100.0) | 8 (66.7) | 6 (75.0) | 8 (61.5) | 5 (55.6) | 5 (31.3) | 6 (37.5) | |
| Length of stay | ||||||||
| Overall LOS, days (SD) | 23.6 (27.9) | 29.8 (31.2) | 31.0 (34.0) | 30.6 (27.9) | 33.5 (31.7) | 32.1 (30.4) | 24.6 (18.9) | 27.3 (23.3) |
| Overall Pre-LOS, days | 11.4 | 8.9 | 10.0 | 8.1 | 8.7 | 9.5 | 8.1 | 8.7 |
| Overall Post-LOS, days | 12.2 | 20.9 | 21.0 | 22.5 | 24.8 | 22.6 | 16.5 | 18.6 |
| 30-day readmission rate, n (%) | 41 (38.1) | 62 (34.1) | 43 (32.0) | 52 (27.9) | 60 (29.3) | 89 (30.2) | 135 (31.1) | 182 (29.7) |
| By age group | ||||||||
| 65–74, n (%) | 29 (36.1) | 49 (32.8) | 36 (33.9) | 42 (31.2) | 50 (29.0) | 69 (29.2) | 107 (30.8) | 136 (28.0) |
| ≥75, n (%) | 13 (50.0) | 12 (38.9) | 6 (23.1) | 8 (17.2) | 10 (31.8) | 20 (34.8) | 28 (32.8) | 44 (36.3) |
| By gender | ||||||||
| Female, n (%) | 7 (25.0) | 19 (42.9) | 13 (46.7) | 5 (15.8) | 14 (32.3) | 14 (41.4) | 20 (34.0) | 27 (28.4) |
| Male, n (%) | 33 (41.2) | 44 (32.4) | 30 (28.3) | 46 (30.1) | 47 (28.4) | 74 (28.6) | 115 (30.7) | 155 (29.9) |
| By race | ||||||||
| White, n (%) | 34 (35.9) | 56 (36.2) | 39 (34.9) | 39 (25.2) | 53 (29.0) | 76 (29.7) | 118 (30.8) | 159 (29.7) |
| Black, n (%) | 4 (66.7) | 5 (37.5) | 14 (22.2) | 8 (41.7) | 6 (41.7) | 10 (41.2) | 13 (37.9) | 15 (32.5) |
| Other*, n (%) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 6 (42.9) | 0 (0.0) | 4 (23.1) | 3 (20.0) | 7 (23.8) |
| Major discharge disposition | ||||||||
| Home, n (%) | 13 (12.1) | 23 (12.7) | 25 (18.8) | 36 (19.5) | 44 (21.4) | 60 (20.3) | 79 (18.2) | 110 (18.0) |
| Home care, n (%) | 15 (14.0) | 30 (16.6) | 24 (18.0) | 41 (22.2) | 64 (31.1) | 95 (32.2) | 133 (30.7) | 213 (34.8) |
| Skilled nursing facility, n (%) | 5 (4.7) | 9 (5.0) | 4 (3.0) | 17 (9.2) | 8 (3.9) | 14 (4.7) | 17 (3.9) | 18 (2.9) |
| Rehospitalisation-related outcomes | ||||||||
| 1-year survival rate, n (%) | 45 (42.0) | 88 (49.0) | 77 (58.0) | 124 (67.0) | 148 (72.0) | 235 (80.0) | 348 (80.0) | |
| Rehospitalisation rate, n (%) | 32 (70.0) | 70 (80.0) | 62 (80.0) | 91 (70.0) | 122 (80.0) | 181 (80.0) | 281 (80.0) | |
| Average number of rehospitalisations | 1.8 | 2.2 | 2.1 | 2.1 | 2.3 | 2.1 | 2.3 | |
| Rehospitalisation duration, mean days (SD) | 30.2 (46.0) | 21.5 (24.8) | 22.2 (26.6) | 22.8 (28.8) | 27.8 (32.6) | 20.2 (25.9) | 20.8 (26.9) | |
| CMS payment for index hospitalisations, $USD | ||||||||
| Unadjusted | $152 035 | $180 160 | $188 799 | $187 797 | $207 653 | $220 188 | $214 685 | $225 697 |
| Adjusted for inpatient hospital PPS | $188 789 | $216 566 | $218 853 | $210 534 | $225 357 | $230 657 | $220 267 | $225 697 |
| CMS payment for rehospitalisations, $USD | ||||||||
| Unadjusted | $50 110 | $40 680 | $54 780 | $43 460 | $82 120 | $56 480 | $53 630 | |
| Adjusted for inpatient hospital PPS | $60 647 | $47 661 | $61 891 | $47 487 | $86 863 | $57 666 | $53 630 | |
*Includes Asian, Hispanic, North American Native or other not specified.
CMS, Centers for Medicare & Medicaid Services; LOS, length of stay; LVAD, left ventricular assist device; PPS, prospective payment system; USD, US Dollars.