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Left Ventricular Assist Devices in Recipients With and Without End-stage Renal Disease.

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eMediNexus    26 December 2017

A new study published in the JAMA Internal Medicine aimed to determine the utilization of and outcomes associated with left ventricular assist devices (LVADs) in nationally representative cohorts of patients with and without end-stage renal disease (ESRD). This study described LVAD utilization and outcomes among Medicare beneficiaries after ESRD onset (defined as having received maintenance dialysis or a kidney transplant) from 2003 to 2013 based on Medicare claims linked to data from the United States Renal Data System (USRDS), and compared Medicare beneficiaries with ESRD to a 5% sample of Medicare beneficiaries without ESRD. The results revealed that among patients with ESRD, the mean age was 58.4 years and 62.0% were males. While, among those without ESRD, the mean age was 62.2 years and 75.1% were males. From 2003 to 2013, 155 Medicare beneficiaries with ESRD and 261 beneficiaries without ESRD in the Medicare 5% sample received an LVAD. However, during a median follow-up of 762 days, 81.9% patients with and 36.4% patients without ESRD died; more than half of patients with ESRD (51.6%) and 4% of those without ESRD died during the index hospitalization. The median time to death was 16 days for patients with ESRD compared to 2125 days for those without ESRD. With adjustment for demographics, comorbidity and time period, patients with ESRD had a considerably increased adjusted risk of death, especially in the first 60 days after LVAD placement. Hence, it was inferred that patients with ESRD at the time of LVAD placement had an extremely poor prognosis, with most surviving for less than 3 weeks. It was stated that this finding may be crucial in supporting shared decision-making around treatments for advanced heart failure in patients with ESRD.

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