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Heart
Pumps for Medicare Patients linked with poor
outcomes
Newswise — Medicare patients who receive
ventricular assist devices (a type of heart
pump) have high rates of death, illness,
prolonged hospital stays, with resulting
high costs of care, according to a study in
the November 26 issue of JAMA.
A ventricular assist device consists of a
mechanical pump that takes over the function
of a damaged ventricle of the heart and
helps restore normal blood flow.
These devices are used primarily in patients
with end-stage heart failure who are
awaiting heart transplantation, as
“destination,” or permanent therapy for
patients who are not candidates for
transplantation, or as a rescue procedure
for patients with shock after open-heart
surgery that is not responding to treatment,
according to background information in the
article.
In 2003, Medicare expanded coverage of
ventricular assist devices as permanent
therapy for end-stage heart failure. Little
is known about the long-term outcomes and
costs associated with these devices.
Adrian F. Hernandez, M.D., M.H.S., of Duke
University School of Medicine, Durham, N.C.,
and colleagues analyzed trends in use,
outcomes and costs of ventricular assist
devices for all Medicare fee-for-service
beneficiaries from February 2000 through
June 2006 by examining inpatient claims from
the Centers for Medicare & Medicaid Services
for this period.
This study included beneficiaries who
received a ventricular assist device as
primary therapy (primary device group; n =
1,476) or after cardiotomy (heart surgery,
such as coronary bypass surgery or valve
replacement surgery) in the previous 30 days
(postcardiotomy group; n = 1,467).
The researchers found that overall 1-year
survival, regardless of subsequent heart
transplantation or device removal, was 51.6
percent (n = 669) in the primary device
group and 30.8 percent (n = 424) in the
postcardiotomy group. Of the 815 patients in
the primary device group who were discharged
alive with a device, 55.6 percent were
readmitted within 6 months.
On average, these patients spent 29.8 days
in the hospital during the subsequent 2
years; survival was 64.7 percent at 2 years.
Among patients in the postcardiotomy group
who were discharged alive with a device (n =
493), 48.3 percent were readmitted within 6
months.
These patients spent an average of 16.7 days
in the hospital during the subsequent 2
years; survival was 69.4 percent at 2 years.
For patients in the 2000 through 2005
groups, the average Medicare payment to
hospitals for inpatient care in the first
year after implantation of a ventricular
assist device was $144,298 per patient.
One-year Medicare payments for inpatient
care of primary device patients totaled
approximately $228 million, and was about
$151 million for inpatient care of
postcardiotomy patients.
“Ventricular assist devices are an evolving
technology with modest adoption in the
Medicare population. Mortality, morbidity,
and costs remain high, so periodic
surveillance using Medicare claims may
complement other postmarketing surveillance
efforts,” they write.
“Improving outcomes will require a focus on
the high perioperative [around the time of
surgery] mortality found in this and other
studies. Identifying patients who are likely
to benefit from ventricular assist devices
and excluding those whose likelihood of
survival is low is warranted.”
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