Resource utilization and hospital readmission associated with gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices
Gastrointestinal bleeding (GIB) occurs in up to 40% of patients with continuous-flow (CF) left ventricular assist devices (LVADs). We sought to identify targets to improve hospital resource utilization and decrease readmissions after GIB. We performed a single-center, retrospective analysis of LVAD-associated GIB resulting in hospital admission between July 2011 and April 2014. Follow-up data were collected through March 2015. We analyzed 57 admissions for GIB in 23 patients. One or more diagnostic imaging study was performed in 47% of admissions, with a definite or probable source of GIB identified in 23%. A total of 76 endoscopies were performed (≥ 1 endoscopy in 79% of admissions, ≥ 2 in 42%). Definite or probable bleeding sources were identified in 25% and 12% of endoscopies, respectively. Patients who underwent multiple endoscopies were no more likely to have a bleeding source identified (OR 1.48; 95% CI 0.50–4.32; p = 0.59) and had longer hospital stays (11.1 vs. 7.8 days, p < 0.02). Readmission rates for GIB at 30 and 90 days were 33% and 53%, respectively. A decrease in antiplatelet regimen at discharge was associated with lower rate of readmission for GIB (OR 0.16; 95% CI 0.03–0.82; p = 0.03) or any cause (OR 0.21; 95% CI 0.05–0.85; p = 0.04) at 30 and 90 days. GIB in patients with CF-LVADs is associated with significant in-hospital resource utilization and high rates of readmission. Imaging and endoscopy are common, but have low diagnostic yield and infrequently result in successful intervention. Strategies to reduce resource utilization and prevent readmission are warranted.
KeywordsLeft ventricular assist device Gastrointestinal bleeding Resource utilization Readmission
Continuous flow left ventricular assist device
Fresh frozen plasma
HeartWare ventricular assist device
Intensive care unit
International normalized ratio
Time in therapeutic range
Video capsule endoscopy
Compliance with ethical standards
Conflict of interest
Dr. Mehra reports non-financial support and other from Abbott, Inc (previously St. Jude Medical), personal fees from Medtronic, personal fees from Janssen (Johnson and Johnson), personal fees from Mesoblast, personal fees from Portola, personal fees from NuPulseCV, Inc, personal fees from Bayer, outside the submitted work. All other authors report no conflicts of interest relative to above manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was not required for this study given the retrospective, observational study design.
- 2.Crow S, John R, Boyle A, Shumway S, Liao K, Colvin-Adams M, Toninato C, Missov E, Pritzker M, Martin C, Garry D, Thomas W, Joyce L (2009) Gastrointestinal bleeding rates in recipients of nonpulsatile and pulsatile left ventricular assist devices. J Thorac Cardiovasc Surg 137:208–215CrossRefPubMedCentralGoogle Scholar
- 8.Hasin T, Marmor Y, Kremers W, Topilsky Y, Severson CJ, Schirger JA, Boilson BA, Clavell AL, Rodeheffer RJ, Frantz RP, Edwards BS, Pereira NL, Stulak JM, Joyce L, Daly R, Park SJ, Kushwaha SS (2013) Readmissions after implantation of axial flow left ventricular assist device. J Am Coll Cardiol 61:153–163CrossRefPubMedCentralGoogle Scholar
- 15.Shrode CW, Draper KV, Huang RJ, Kennedy JL, Godsey AC, Morrison CC, Shami VM, Wang AY, Kern JA, Bergin JD, Ailawadi G, Banerjee D, Gerson LB, Sauer BG (2014) Significantly higher rates of gastrointestinal bleeding and thromboembolic events with left ventricular assist devices. Clin Gastroenterol Hepatol 12:1461–1467CrossRefPubMedCentralGoogle Scholar
- 21.Litzler PY, Smail H, Barbay V, Nafeh-Bizet C, Bouchart F, Baste JM, Abriou C, Bessou JP (2014) Is anti-platelet therapy needed in continuous flow left ventricular assist device patients? A single-centre experience. Eur J Cardiothorac Surg 45:55–59 (discussion 59–60)CrossRefPubMedCentralGoogle Scholar
- 25.Juricek C, Imamura T, Nguyen A, Chung B, Rodgers D, Sarswat N, Kim G, Raikhelkar J, Ota T, Song T, Burkhoff D, Sayer G, Jeevanandam V, Uriel N (2018) Long-acting octreotide reduces the recurrence of gastrointestinal bleeding in patients with a continuous-flow left ventricular assist device. J Card Fail 24:249–254CrossRefPubMedCentralGoogle Scholar