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Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries.

Publication ,  Journal Article
Hernandez, AF; Shea, AM; Milano, CA; Rogers, JG; Hammill, BG; O'Connor, CM; Schulman, KA; Peterson, ED; Curtis, LH
Published in: JAMA
November 26, 2008

CONTEXT: In 2003, Medicare expanded coverage of ventricular assist devices as destination, or permanent, therapy for end-stage heart failure. Little is known about the long-term outcomes and costs associated with these devices. OBJECTIVE: To examine the acute and long-term outcomes of Medicare beneficiaries receiving ventricular assist devices alone or after open-heart surgery. DESIGN, SETTING, AND PATIENTS: Analysis of inpatient claims from the Centers for Medicare & Medicaid Services for the period 2000 through 2006. Patients were Medicare fee-for-service beneficiaries who received a ventricular assist device between February 2000 and June 2006 alone as primary therapy (primary device group; n = 1476) or after cardiotomy in the previous 30 days (postcardiotomy group; n = 1467). MAIN OUTCOME MEASURES: Cumulative incidence of device replacement, device removal, heart transplantation, readmission, and death, accounting for censoring and competing risks. Patients were followed up for at least 6 months and factors independently associated with long-term survival were identified. Medicare payments were used to calculate total inpatient costs and costs per day outside the hospital. RESULTS: Overall 1-year survival was 51.6% (n = 669) in the primary device group and 30.8% (n = 424) in the postcardiotomy group. Among primary device patients, 815 (55.2%) were discharged alive with a device. Of those, 450 (55.6%) were readmitted within 6 months and 504 (73.2%) were alive at 1 year. Of the 493 (33.6%) postcardiotomy patients discharged alive with a device, 237 (48.3%) were readmitted within 6 months and 355 (76.6%) were alive at 1 year. Mean 1-year Medicare payments for inpatient care for patients in the 2000-2005 cohorts were $178,714 (SD, $142,549) in the primary device group and $111,769 (SD, $95,413) in the postcardiotomy group. CONCLUSIONS: Among Medicare beneficiaries receiving a ventricular assist device, early mortality, morbidity, and costs remain high. Improving patient selection and reducing perioperative mortality are critical for improving overall outcomes.

Duke Scholars

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

November 26, 2008

Volume

300

Issue

20

Start / End Page

2398 / 2406

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Risk
  • Retrospective Studies
  • Patient Readmission
  • Morbidity
  • Middle Aged
  • Medicare
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hernandez, A. F., Shea, A. M., Milano, C. A., Rogers, J. G., Hammill, B. G., O’Connor, C. M., … Curtis, L. H. (2008). Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries. JAMA, 300(20), 2398–2406. https://doi.org/10.1001/jama.2008.716
Hernandez, Adrian F., Alisa M. Shea, Carmelo A. Milano, Joseph G. Rogers, Bradley G. Hammill, Christopher M. O’Connor, Kevin A. Schulman, Eric D. Peterson, and Lesley H. Curtis. “Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries.JAMA 300, no. 20 (November 26, 2008): 2398–2406. https://doi.org/10.1001/jama.2008.716.
Hernandez AF, Shea AM, Milano CA, Rogers JG, Hammill BG, O’Connor CM, et al. Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries. JAMA. 2008 Nov 26;300(20):2398–406.
Hernandez, Adrian F., et al. “Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries.JAMA, vol. 300, no. 20, Nov. 2008, pp. 2398–406. Pubmed, doi:10.1001/jama.2008.716.
Hernandez AF, Shea AM, Milano CA, Rogers JG, Hammill BG, O’Connor CM, Schulman KA, Peterson ED, Curtis LH. Long-term outcomes and costs of ventricular assist devices among Medicare beneficiaries. JAMA. 2008 Nov 26;300(20):2398–2406.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

November 26, 2008

Volume

300

Issue

20

Start / End Page

2398 / 2406

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Risk
  • Retrospective Studies
  • Patient Readmission
  • Morbidity
  • Middle Aged
  • Medicare
  • Male