PMID- 36811897 OWN - NLM STAT- MEDLINE DCOM- 20230414 LR - 20240425 IS - 2168-6262 (Electronic) IS - 2168-6254 (Print) IS - 2168-6254 (Linking) VI - 158 IP - 4 DP - 2023 Apr 1 TI - Association of Days Alive and Out of the Hospital After Ventricular Assist Device Implantation With Adverse Events and Quality of Life. PG - e228127 LID - 10.1001/jamasurg.2022.8127 [doi] LID - e228127 AB - IMPORTANCE: There is a need to better assess the cumulative effect on morbidity and mortality in patients undergoing durable left ventricular assist device (LVAD) implantation. This study evaluates a patient-centered performance metric (days alive and out of hospital [DAOH]) for durable LVAD therapy. OBJECTIVE: To determine the incidence of percent of DAOH before and after LVAD implantation and (2) explore its association with established quality metrics (death, adverse events [AEs], quality of life). DESIGN, SETTINGS, AND PARTICIPANTS: This was a retrospective national cohort study of Medicare beneficiaries implanted with a durable continuous-flow LVAD between April 2012 and December 2016. The data were analyzed from December 2021 to May 2022. Follow-up was 100% complete at 1 year. Data from The Society of Thoracic Surgeons Intermacs registry were linked to Medicare claims. MAIN OUTCOMES AND MEASURES: The number of DAOH 180 days before and 365 days after LVAD implantation and daily patient location (home, index hospital, nonindex hospital, skilled nursing facility, rehabilitation center, hospice) were calculated. Percent of DAOH was indexed to each beneficiary's pre- (percent DAOH-BF) and postimplantation (percentage of DAOH-AF) follow-up time. The cohort was stratified by terciles of percentage of DAOH-AF. RESULTS: Among the 3387 patients included (median [IQR] age: 66.3 [57.9-70.9] years), 80.9% were male, 33.6% and 37.1% were Interfaces Patient Profile 2 and 3, respectively, and 61.1% received implants as destination therapy. Median (IQR) percent of DAOH-BF was 88.8% (82.7%-93.8%) and 84.6% (62.1-91.5%) for percent of DAOH-AF. While DAOH-BF was not associated with post-LVAD outcomes, patients in the low tercile of percentage of DAOH-AF had a longer index hospitalization stay (mean, 44 days; 95% CI, 16-77), were less likely to be discharged home (mean. -46.4 days; 95% CI, 44.2-49.1), and spent more time in a skilled nursing facility (mean, 27 days; 95% CI, 24-29), rehabilitation center (mean, 10 days; 95% CI, 8-12), or hospice (mean, 6 days; 95% CI, 4-8). Increasing percentage of DAOH-AF was associated with patient risk, AEs, and indices of HRQoL. Patients experiencing non-LVAD-related AEs had the lowest percentage of DAOH-AF. CONCLUSIONS AND RELEVANCE: Significant variability existed in the percentage of DAOH within a 1-year time horizon and was associated with the cumulative AEs burden. This patient-centered measure may assist clinicians in informing patients about expectations after durable LVAD implantation. Validation of percentage DAOH as a quality metric for LVAD therapy across centers should be explored. FAU - Noly, Pierre-Emmanuel AU - Noly PE AD - Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor. AD - Now with the Montreal Heart Institute, Universite de Montreal, Quebec, Montreal, Canada. FAU - Wu, Xiaoting AU - Wu X AD - Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor. FAU - Hou, Hechuan AU - Hou H AD - Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor. FAU - Grady, Kathleen L AU - Grady KL AD - Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. FAU - Stewart, James W 2nd AU - Stewart JW 2nd AD - Division of Cardiac Surgery, Yale School of Medicine New Haven, Connecticut. FAU - Hawkins, Robert B AU - Hawkins RB AD - Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor. FAU - Yang, Guangyu AU - Yang G AD - Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor. FAU - Kim, K Dennie AU - Kim KD AD - Strategy, Ethics, and Entrepreneurship, Darden School of Business, University of Virginia, Charlottesville. FAU - Zhang, Min AU - Zhang M AD - Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor. FAU - Cabrera, Lourdes AU - Cabrera L AD - Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor. FAU - Aaronson, Keith D AU - Aaronson KD AD - Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor. FAU - Pagani, Francis D AU - Pagani FD AD - Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor. FAU - Likosky, Donald S AU - Likosky DS AD - Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor. CN - Michigan Congestive Heart Failure Investigators LA - eng GR - R01 HL164416/HL/NHLBI NIH HHS/United States GR - R01 HL166140/HL/NHLBI NIH HHS/United States GR - HHSN268201100025C/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20230412 PL - United States TA - JAMA Surg JT - JAMA surgery JID - 101589553 SB - IM CIN - JAMA Surg. 2023 Apr 1;158(4):e228138. PMID: 36811900 MH - Aged MH - Humans MH - Male MH - United States/epidemiology MH - Female MH - *Quality of Life MH - *Heart-Assist Devices/adverse effects MH - Retrospective Studies MH - Cohort Studies MH - Medicare MH - Hospitals PMC - PMC9947806 COIS- Conflict of Interest Disclosures: Dr Grady reported personal fees from Amgen and the American Heart Association, and registration and travel expense fees from the International Society for Heart and Lung Transplantation outside the submitted work. Dr Aaronson reported personal fees from Medtronic Independent Physician Quality Panel and research fees from Abbott to the University of Michigan outside the submitted work. Dr Pagani reported grants from the Agency for Healthcare Research & Quality during the conduct of the study. Dr Likosky reported grants from the Agency for Healthcare Research & Quality and the National Institutes of Health, partial salary support from Blue Cross Blue Shield Michigan to their institution, and personal fees from AmSECT outside the submitted work. No other disclosures were reported. FIR - El Ela, Ashraf Shaaban Abdel Aziz Abou IR - El Ela ASAAA FIR - Tang, Paul C IR - Tang PC FIR - Thompson, Michael P IR - Thompson MP FIR - Sassalos, Peter IR - Sassalos P FIR - Shore, Supriya IR - Shore S FIR - Cascino, Thomas M IR - Cascino TM FIR - McCullough, Jeffrey S IR - McCullough JS FIR - Chung, Grace IR - Chung G FIR - Janda, Allison M IR - Janda AM FIR - Brescia, Alexander A IR - Brescia AA FIR - Yost, Gardner L IR - Yost GL FIR - Airhart, Austin IR - Airhart A EDAT- 2023/02/23 06:00 MHDA- 2023/04/14 06:42 PMCR- 2024/02/22 CRDT- 2023/02/22 16:04 PHST- 2023/04/14 06:42 [medline] PHST- 2023/02/23 06:00 [pubmed] PHST- 2023/02/22 16:04 [entrez] PHST- 2024/02/22 00:00 [pmc-release] AID - 2801766 [pii] AID - soi220117 [pii] AID - 10.1001/jamasurg.2022.8127 [doi] PST - ppublish SO - JAMA Surg. 2023 Apr 1;158(4):e228127. doi: 10.1001/jamasurg.2022.8127. Epub 2023 Apr 12.