Abstract 19: U.S. Trends in Left Ventricular Assist Device Use and Outcomes: An Analysis of Medicare Administrative Data

Abstract

BACKGROUND: Left Ventricular Assist Devices (LVAD) have become the treatment of choice for many patients with advanced symptomatic heart failure who are not candidates for heart transplant (destination therapy) or who are waiting for a donor heart (bridge therapy). Little is however known about contemporary trends in LVAD volume, per-capita utilization and mortality especially among older patients. We examined trends related to LVAD implantation among the U.S. Medicare population. METHODS: Using Medicare inpatient data (MedPAR), we identified all fee-for-service beneficiaries age 65 and older who received LVADs between 2006 and 2010 using ICD-9 code 37.66. We examined the number of LVADs implanted each year and per-capita utilization (LVADs per 100,000 Medicare enrollees per-year) for every year during our study period. We also examined mortality rates during the index admission and within 90-days and 365-days from the index admission for each year. Trends over time were compared using Mantel-Haenszel test for trend. RESULTS: The number of LVADs implanted in fee-for-service Medicare beneficiaries age 65 and older increased from 145 in 2006 to 547 in 2010 (an increase of 277%). Among the 1,549 patients who received LVADs, mean age was 70.5 years (84% male, 85% white). Per-capita LVAD utilization increased by 245% from 1.1 per 100,000 patients in 2006, to 3.8 per 100,000 patients in 2010. In-hospital mortality decreased over the study period (40.7% in 2006 to 19.6% in 2010; P<0.0001) while 90-day mortality increased (82.8% in 2006 to 89.8% in 2010; P=0.02) as did one-year mortality (97.2% in 2006 to 100% in 2010; P=0.002). CONCLUSION: The utilization rate of LVADs in the Medicare population increased significantly between 2006 and 2010 and was accompanied by an increase in 90-day and one-year mortality despite a decrease in in-hospital mortality. These results and the trend towards increasing mortality warrant careful attention and consideration by physicians, patients, and policy makers.