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• W4365150240 abstract "Introduction Groundbreaking progress in mechanical support devices for end stage heart failure has created such advanced therapies that the complexity of left ventricular assist device (LVAD) implantation rivals that of a heart transplant. Yet while transplantation is associated with well respected patient selection criteria, such criteria for LVAD candidates is lacking. LVAD implantation is a serious undertaking on behalf of the patient and health care community. Recent data suggests the cost of readmissions for end stage heart failure was lower before LVAD implantation. Simulated lifetime models reveal LVAD therapy, including cost of the therapy, initial admission and readmissions, almost doubles estimated total treatment costs when compared with medical management. In order to improve this healthcare and patient burden, we need to identify at risk patients and reduce hospital readmissions. The purpose of the LVAD matrix is to appropriately asses candidates’ risk in an effort to minimize a major cost of readmission and maximize quality of life outcomes. Hypothesis The LVAD risk matrix will serve as a successful scoring tool to identify patients who are at risk for an increase in proportion of days in hospital after 30 days post LVAD implantation. Methods 196 LVAD patients who were implanted from October 2012-May 2021were retrospectively assigned a risk matrix score that was based on clinical risk factors categorized into four sections: psychosocial, frailty, medical and surgical. The main sections were divided into further subgroups giving the matrix score a maximum of 12. Patients with higher scores indicated higher risk, with patients totaling 6-9 points needing further evaluation and patients with 10+ points were declined as potential LVAD recipients. We then examined the relationship between the risk matrix score and proportion of days in-hospital after 30 days post-LVAD implantation. Results Of the 196 patient's who were assigned a risk matrix score, patients with higher risk matrix scores tended to have commonalities such as older age, more debilitated condition, Caucasian race and a self identified mental illness. Thirty days post LVAD implantation, patients with higher scores of 4-5 and 6-9 had increased proportion of days in the hospital than outside of the hospital. Conclusions The risk matrix scoring tool is a strong predictor of the proportion of days spent in-hospital after the initial 30 days post-LVAD implantation. This scoring tool allows higher risk patients to be identified prior to implantation. Subsequently, such patients can then undergo more evaluation to hopefully minimize these high risk areas and reduce rates of readmission. Groundbreaking progress in mechanical support devices for end stage heart failure has created such advanced therapies that the complexity of left ventricular assist device (LVAD) implantation rivals that of a heart transplant. Yet while transplantation is associated with well respected patient selection criteria, such criteria for LVAD candidates is lacking. LVAD implantation is a serious undertaking on behalf of the patient and health care community. Recent data suggests the cost of readmissions for end stage heart failure was lower before LVAD implantation. Simulated lifetime models reveal LVAD therapy, including cost of the therapy, initial admission and readmissions, almost doubles estimated total treatment costs when compared with medical management. In order to improve this healthcare and patient burden, we need to identify at risk patients and reduce hospital readmissions. The purpose of the LVAD matrix is to appropriately asses candidates’ risk in an effort to minimize a major cost of readmission and maximize quality of life outcomes. The LVAD risk matrix will serve as a successful scoring tool to identify patients who are at risk for an increase in proportion of days in hospital after 30 days post LVAD implantation. 196 LVAD patients who were implanted from October 2012-May 2021were retrospectively assigned a risk matrix score that was based on clinical risk factors categorized into four sections: psychosocial, frailty, medical and surgical. The main sections were divided into further subgroups giving the matrix score a maximum of 12. Patients with higher scores indicated higher risk, with patients totaling 6-9 points needing further evaluation and patients with 10+ points were declined as potential LVAD recipients. We then examined the relationship between the risk matrix score and proportion of days in-hospital after 30 days post-LVAD implantation. Of the 196 patient's who were assigned a risk matrix score, patients with higher risk matrix scores tended to have commonalities such as older age, more debilitated condition, Caucasian race and a self identified mental illness. Thirty days post LVAD implantation, patients with higher scores of 4-5 and 6-9 had increased proportion of days in the hospital than outside of the hospital. The risk matrix scoring tool is a strong predictor of the proportion of days spent in-hospital after the initial 30 days post-LVAD implantation. This scoring tool allows higher risk patients to be identified prior to implantation. Subsequently, such patients can then undergo more evaluation to hopefully minimize these high risk areas and reduce rates of readmission." @default.
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• W4365150240 date "2023-04-01" @default.
• W4365150240 modified "2023-09-25" @default.
• W4365150240 title "A Scoring Matrix For Pre-Left Ventricular Device Patient Selection: Predicting Hospital Readmissions" @default.
• W4365150240 doi "https://doi.org/10.1016/j.cardfail.2022.10.154" @default.
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