JAMA: Heart pumps can lead to high costs, high mortality rates
Ventricular assist devices (VADs) are associated with high hospital costs and high rates of early death among Medicare recipients, according to a study in the Nov. 26 issue of the Journal of the American Medical Association.
“VADs are an emerging technology and while they have been proven effective in extending life, more needs to be done before they can be more widely adopted in patients with heart failure. Also, as physicians, we need to do a better job defining the time of optimal intervention and identifying who is most likely to benefit from a VAD,” said study author Adrian Hernandez, MD, a cardiologist at Duke University Medical Center in Durham, N.C.
Hernandez and fellow Duke researchers analyzed data on nearly 3,000 Medicare patients who received a VAD between 2000 and 2006. Half the patients received a VAD as a primary strategy for treatment of heart failure and the other half received a VAD after cardiac surgery.
Among the primary group, the investigators said that 55 percent of patients were discharged alive with a VAD after a median hospital stay of 30 days. By one year, 20 percent of the primary group had undergone transplant, 5 percent had the device removed, 42 percent had died and 32 percent were alive with the device.
In the post-surgical group, they found that one-third of the patients were discharged alive with a device, and the median hospital stay was 10 days. At one year, a quarter of the group was alive with a VAD in place.
Investigators also found that care did not end with the initial hospitalization. About half the patients in both groups had to be re-hospitalized within six months. The mean Medicare hospital costs for the primary group neared $200,000, but the cost for patients in the post-surgery group was closer to $100,000.
"The figures are somewhat discouraging, but we have to remember that all of these are very high-risk patients to begin with. They were elderly and in grave condition because of their failing hearts. Without a VAD, they probably would not have survived," said Hernandez.
As with other surgical procedures, volume appeared to matter. Higher volume was significantly associated with lower risk of death. The risk of death 31 was percent lower in hospitals performing at least five procedures per year, the authors wrote.
“VADs are an emerging technology and while they have been proven effective in extending life, more needs to be done before they can be more widely adopted in patients with heart failure. Also, as physicians, we need to do a better job defining the time of optimal intervention and identifying who is most likely to benefit from a VAD,” said study author Adrian Hernandez, MD, a cardiologist at Duke University Medical Center in Durham, N.C.
Hernandez and fellow Duke researchers analyzed data on nearly 3,000 Medicare patients who received a VAD between 2000 and 2006. Half the patients received a VAD as a primary strategy for treatment of heart failure and the other half received a VAD after cardiac surgery.
Among the primary group, the investigators said that 55 percent of patients were discharged alive with a VAD after a median hospital stay of 30 days. By one year, 20 percent of the primary group had undergone transplant, 5 percent had the device removed, 42 percent had died and 32 percent were alive with the device.
In the post-surgical group, they found that one-third of the patients were discharged alive with a device, and the median hospital stay was 10 days. At one year, a quarter of the group was alive with a VAD in place.
Investigators also found that care did not end with the initial hospitalization. About half the patients in both groups had to be re-hospitalized within six months. The mean Medicare hospital costs for the primary group neared $200,000, but the cost for patients in the post-surgery group was closer to $100,000.
"The figures are somewhat discouraging, but we have to remember that all of these are very high-risk patients to begin with. They were elderly and in grave condition because of their failing hearts. Without a VAD, they probably would not have survived," said Hernandez.
As with other surgical procedures, volume appeared to matter. Higher volume was significantly associated with lower risk of death. The risk of death 31 was percent lower in hospitals performing at least five procedures per year, the authors wrote.