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Resource utilization and hospital readmission associated with gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices

  • Anthony P. Carnicelli
  • Anjali Thakkar
  • David J. Deicicchi
  • Andrew C. Storm
  • Jessica Rimsans
  • Jean M. Connors
  • Mandeep R. Mehra
  • John D. Groarke
  • Michael M. Givertz
Article

Abstract

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.

Keywords

Left ventricular assist device Gastrointestinal bleeding Resource utilization Readmission 

Abbreviations

CF-LVAD

Continuous flow left ventricular assist device

CI

Confidence interval

CT

Computed tomography

EGD

Esophagogastroduodenoscopy

FFP

Fresh frozen plasma

GIB

Gastrointestinal bleeding

HVAD

HeartWare ventricular assist device

ICU

Intensive care unit

INR

International normalized ratio

IQR

Interquartile range

OR

Odds ratio

PF

Pulsatile flow

TTR

Time in therapeutic range

VCE

Video capsule endoscopy

Notes

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.

Ethical approval

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

Informed consent was not required for this study given the retrospective, observational study design.

Supplementary material

11239_2018_1781_MOESM1_ESM.docx (74 kb)
Supplementary material 1 (DOCX 73 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Anthony P. Carnicelli
    • 1
    • 5
  • Anjali Thakkar
    • 1
    • 6
  • David J. Deicicchi
    • 1
    • 2
  • Andrew C. Storm
    • 1
    • 3
  • Jessica Rimsans
    • 1
    • 2
  • Jean M. Connors
    • 1
    • 4
  • Mandeep R. Mehra
    • 1
    • 2
  • John D. Groarke
    • 1
    • 2
  • Michael M. Givertz
    • 1
    • 2
  1. 1.Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  2. 2.Cardiovascular Division, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Division of Gastroenterology and Hepatology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  4. 4.Division of Hematology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  5. 5.Division of Cardiology, Department of MedicineDuke University HospitalDurhamUSA
  6. 6.Department of MedicineUniversity of California San FranciscoSan FranciscoUSA

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