Post-acute Care Trajectories in the First Year Following Hospital Discharge After Left Ventricular Assist Device Implantation

Introduction Patients with advanced heart failure who undergo left ventricular assist device (LVAD) implantation are heavy users of post-acute care services. We sought to better describe the post-acute trajectories and burden of care transitions for this patient population. Methods and results We conducted a retrospective cohort study of 227 patients who were discharged after index hospitalization for LVAD implantation. Of these, 162 (71%) were discharged home, and 65 (29%) were discharged to a facility, including long-term acute care hospitals (n = 50), inpatient rehabilitation facilities (n = 11), and skilled nursing facilities (n = 4). Follow-up extended to 1 year, with censoring at date of heart transplantation, LVAD removal, death, or loss of follow- up. In the first year post-discharge, those patients initially discharged home spent a mean 265 days at home, 0.5 days in a facility, and 13 days in the hospital as result of readmission. Those initially discharged to a facility spent a mean 241 days at home, 37 days in a facility, and 19 days in the hospital as result of readmission. Patients initially discharged home experienced fewer care transitions, 4.2 vs 5.2 transitions per patient, compared with those initially discharged to a facility. Conclusions In the first year following index hospitalization for LVAD implantation, patients initially discharged to a facility have an increased burden of care transitions, as well as time spent in the hospital and in a facility, compared with patients initially discharged home. Specialized models of care are needed in facilities caring for patients with LVADs.