Medicare patients who receive ventricular assist devices (a type of heart pump) have high rates of death, illness, prolonged hospital stays, with resulting high costs of care, according to a study in the November 26 issue of JAMA, the Journal of the American Medical Association.
A ventricular assist device consists of a mechanical pump that takes over the function of a damaged ventricle of the heart and helps restore normal blood flow. These devices are used primarily in patients with end-stage heart failure who are awaiting heart transplantation, as "destination," or permanent therapy for patients who are not candidates for transplantation, or as a rescue procedure for patients with shock after open-heart surgery that is not responding to treatment, according to background information in the article. In 2003, Medicare expanded coverage of ventricular assist devices as permanent therapy for end-stage heart failure. Little is known about the long-term outcomes and costs associated with these devices.
Adrian F. Hernandez, M.D., M.H.S., of Duke University School of Medicine, Durham, N.C., and colleagues analyzed trends in use, outcomes and costs of ventricular assist devices for all Medicare fee-for-service beneficiaries from February 2000 through June 2006 by examining inpatient claims from the Centers for Medicare & Medicaid Services for this period. This study included beneficiaries who received a ventricular assist device as primary therapy (primary device group; n = 1,476) or after cardiotomy (heart surgery, such as coronary bypass surgery or valve replacement surgery) in the previous 30 days (postcardiotomy group; n = 1,467).