Less than half of patients with end-stage renal disease who received left ventricular assist devices survived to hospital discharge, with most surviving less than 3 weeks postoperatively, according to recent study results.
Researchers compared rates of survival after LVAD in 155 Medicare beneficiaries with ESRD and 261 patients without ESRD from a 5% sample of Medicare beneficiaries.
The data showed that for the years 2003-2006, patients with ESRD had an incidence rate of LVAD placement per 10,000 person-years of 0.32, while those without ESRD had a rate of 0.06. For 2009, these rates were 0.47 in the ESRD group and 0.13 for those without ESRD. The 2010-2013 rates were 0.45 for those with ESRD and 0.25 for those without ESRD. Results also showed 81.9% of patients with and 36.4% of patients without ESRD died during a median follow-up of 762 days. During the index hospitalization, researchers found 51.6% of patients with ESRD and 4% of patients without ESRD died. Patients with ESRD had a median time to death of 16 days vs. 2,125 days among patients without ESRD, according to the results. Researchers found a markedly increased adjusted risk for death among patients with ESRD, especially in the first 60 days after LVAD placement, after adjusting for demographics, comorbidity and time period.
“Our results may help to inform treatment decisions in patients with ESRD and heart failure who are contemplating LVAD placement,” the authors wrote. “These patients should ideally be informed about the very poor prognosis of most patients with ESRD who receive an LVAD. In the context of each patients’ goals and values, this information should then factor into shared decision-making around LVAD placement.” – by Casey Tingle
Bansal N, et al. JAMA Intern Med. 2018;doi:10.1001/jamainternmed.2017.4831.
Disclosures: The authors report no relevant financial disclosures.