Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
ESC Heart Fail. 2024 Aug;11(4):1919-1931. doi: 10.1002/ehf2.14750. Epub 2024 Mar 15.
Increasing numbers of patients with advanced heart failure and significant comorbidity and social barriers are considered for left ventricular assist devices (LVADs). We sought to examine health care utilization post-LVAD implantation, including the influence of individual-level socio-economic position and multimorbidity.
We conducted a Danish nationwide cohort study linking individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish national medical and administrative registries. Socio-economic position included cohabitation status, educational level, and employment status. Multimorbidity was defined as two or more chronic conditions from at least two chronic disease groups. Health care utilization (hospital activity, general practice activity, and redeemed medical prescriptions) within 2 years post-discharge after LVAD implantation was evaluated using descriptive statistics at 0.5 year intervals. We identified 119 patients discharged alive with first-time LVAD implanted between 2006 and 2018. The median age of the patients was 56.1 years, and 88.2% were male. Patients were followed until heart transplantation, LVAD explantation, death, 31 December 2018, or for 2 years. The median follow-up was 0.8 years. The highest median use of health care services was observed 0-0.5 years post-LVAD discharge compared with the subsequent follow-up intervals: 0.5-1, 1-1.5, and 1.5-2 years, respectively. The median (interquartile range) number of hospitalizations was 10 (7-14), bed days 14 (9-28), outpatient visits 8 (5-12), telephone contacts with a general practitioner 4 (2-8), and total redeemed medical prescriptions 26 (19-37) within 0-0.5 years post-LVAD discharge compared with the median utilization within the consecutive follow-up periods [e.g. within 0.5-1 year: hospitalizations 5 (3-8), bed days 8 (4-14), outpatient visits 5 (3-8), telephone contacts 2 (0-5), and redeemed medical prescriptions 24 (18-30)]. The median use of health care services was stable from 0.5 years onwards. The median number of hospitalizations and bed days was slightly higher in patients living alone with a low educational level or low employment status within 0-0.5 years post-LVAD implantation. Finally, the median number of in-hospital days and redeemed prescriptions was higher among patients with pre-existing multimorbidity.
Among patients who underwent LVAD implantation, health care utilization was high in the early post-LVAD discharge phase and was influenced by socio-economic position. Multimorbidity influenced the number of in-hospital days and redeemed prescriptions during the 2 year follow-up.
越来越多患有晚期心力衰竭和严重合并症及社会障碍的患者被考虑接受左心室辅助装置（LVAD）治疗。我们旨在研究 LVAD 植入术后的医疗保健利用情况，包括个体社会经济地位和多种合并症的影响。
我们进行了一项丹麦全国性队列研究，将个体数据与临床 LVAD 数据库、Scandiatransplant 数据库和丹麦国家医疗和行政登记处相关联。社会经济地位包括同居状况、教育程度和就业状况。多种合并症定义为至少两种来自两个或多个慢性疾病组的慢性疾病。使用描述性统计方法，在 LVAD 植入后 0.5 年的间隔内评估出院后 2 年内（0.5-1 年、1-1.5 年和 1.5-2 年）的出院后患者的医疗保健服务利用情况（医院活动、全科医生活动和已配药）。我们确定了 119 名在 2006 年至 2018 年间首次植入 LVAD 且存活出院的患者。患者的中位年龄为 56.1 岁，88.2%为男性。患者接受随访直至心脏移植、LVAD 取出、死亡、2018 年 12 月 31 日或 2 年。中位随访时间为 0.8 年。与随后的随访间隔相比，LVAD 出院后 0-0.5 年观察到最高的医疗保健服务中位使用率：0.5-1 年、1-1.5 年和 1.5-2 年。与连续随访期间的中位使用率相比，LVAD 出院后 0-0.5 年内的中位（四分位距）住院次数为 10（7-14），住院天数为 14（9-28），门诊就诊次数为 8（5-12），全科医生电话联系次数为 4（2-8），总配药处方数为 26（19-37）[例如，在 0.5-1 年内：住院次数为 5（3-8），住院天数为 8（4-14），门诊就诊次数为 5（3-8），电话联系次数为 2（0-5），配药处方数为 24（18-30）]。LVAD 出院后 0.5 年及以后，医疗保健服务的中位使用率保持稳定。在 LVAD 植入术后 0-0.5 年内，独居、教育程度低或就业状况低的患者住院次数和住院天数的中位值略高。最后，合并症较多的患者住院天数和配药处方的中位值较高。
在接受 LVAD 植入的患者中，LVAD 出院后的早期医疗保健利用度较高，且受社会经济地位影响。多种合并症影响了 2 年随访期间的住院天数和配药处方数。
