E313 JACC April 5, 2011 Volume 57, Issue 17

CARDIAC FUNCTION AND HEART FAILURE

INCREMENTAL COST OF RIGHT VENTRICULAR FAILURE AFTER LEFT VENTRICULAR ASSIST DEVICE PLACEMENT
ACC Poster Contributions
Ernest N. Morial Convention Center, Hall F Monday, April 04, 2011, 9:30 a.m.-10:45 a.m.

Session Title: Cardiac Tranplantation/Assist Devices -- Basic and Clinical

Abstract Category: 23. Cardiac Transplantation/Assist DevicesBasic and Clinical Session-Poster Board Number: 1087-4 Authors: Alexander Iribarne, Sang-Woo Pak, Mark J. Russo, Rachel Easterwood, Jonathan Yang, Hiroo Takayama, Donna Mancini, Yoshifumi Naka, Columbia University Medical Center, New York, NY, University of Chicago, Chicago, IL Background: To quantify the incremental cost associated with right ventricular failure (RVF) after left ventricular assist device (LVAD) placement. Methods: Data on HeartMate XVE (n=107) and HeartMate II (n=58) LVAD recipients from 1/1/03-1/1/09 at our institution were retrospectively reviewed. Total hospital costs were adjusted to post-op costs using multivariable regression and stratified by billing category (Table 1). Clinical outcomes included: development of post-op RVF, need for RVAD, ICU length of stay (LOS), and in-hospital mortality. Results: Among all LVAD recipients, 28.5% (n=47) were diagnosed with post-op RVF, and of these 42.6% (n=20) required an RVAD. RVF was associated with a mean $89,955 34,279 higher post-op cost of hospitalization (p=0.01). The increased cost of RVF was driven by an increase in mean direct ($71,375 21,012; p=0.001) versus indirect ($23,007 21,413; p=0.284) costs. RVF requiring insertion of an RVAD was associated with a $273,619 34,359 higher post-op cost of hospitalization (p<0.0001), and RVF was associated with a mean 7.8 2.8 day longer ICU LOS (p=0.007). Although there was a trend toward increased in-hospital mortality among RVF (23.4%, n=11) versus non-RVF patients (11.9%, n=14), the difference did not achieve statistical significance (p=0.09). Conclusions: RVF after LVAD placement is associated with a significant increase in post-operative costs. Efforts aimed at predicting and preventing RVF have the potential for significant cost-savings. Table 1: Incremental mean post-op costs associated with RVF by select billing categories Mean difference in cost ($) Billing category (Cost RVF - Cost non-RVF) Blood bank 4,819 2,550 Cardiac imaging 324 149 Cardiac cath lab 3,992 1,660 Diagnostic lab 3,726 1,732 Boarding and nursing 26,300 16,139 Operating room 7,343 8,756 Pharmacy 14,226 7,673 Radiology 1,161 1,145 Respiratory care 4,815 2,009

p-value 0.061 0.031 0.018 0.033 0.105 0.403 0.066 0.312 0.018

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