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

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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.

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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

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Authors and Affiliations

  1. Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    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

  2. Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    David J. Deicicchi, Jessica Rimsans, Mandeep R. Mehra, John D. Groarke & Michael M. Givertz

  3. Division of Gastroenterology and Hepatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Andrew C. Storm

  4. Division of Hematology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Jean M. Connors

  5. Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, NC, USA

    Anthony P. Carnicelli

  6. Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Anjali Thakkar

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  1. Anthony P. Carnicelli
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Correspondence to Michael M. Givertz.

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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.

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

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Carnicelli, A.P., Thakkar, A., Deicicchi, D.J. et al. Resource utilization and hospital readmission associated with gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices. J Thromb Thrombolysis 47, 375–383 (2019). https://doi.org/10.1007/s11239-018-1781-4

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  • DOI: https://doi.org/10.1007/s11239-018-1781-4

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