Preoperative Predictors for Length of ICU Admission after Ventricular Assist Device (VAD) Implantation as Bridge to Transplant—A Single Centre Experience

Background: Patients admitted for decompensated heart failure (HF) have high readmission rates. Data are lacking regarding the cause and predictors of readmission in this patient group who often have multiple co-morbidities. Aim: To determine the rate, cause and predictors of readmission in patients with HF in a rural centre. Methods:We identified all patients admitted to Orange Health Service (OHS) over a six month period, July 2011–January 2012, with a primary discharge DRG diagnosis of HF. We analysed deaths and readmissions over the next 12 months. Results: Seventy-two patients were admitted with a primary diagnosis of HF in six months. Mean age was 75.4 years (54.2% male). There were 17 deaths (23.6%); primarily cardiac (69%) and respiratory (30.8%) causes. Only 21.7% of patients were not readmitted during the 12 months. There were 122 readmissions and 44 ED presentations in the remaining 58 patients averaging 2.4 readmissions and 2.9 presentations per patient using 421 bed days. Causes of readmission were; decompensated HF (35.7%), ischaemia or arrhythmia (9.9%), respiratory (8.1%), sepsis (6.7%), renal failure or complications of therapy (2.7%), other medical/surgical (25%), elective (7.1%). There was no difference in readmission rates between patients with preserved (49%) vs impaired (51%) EF. Univariate analysis showed IHD was a predictor of readmission (p= 0.029).No other baselines characteristicswere predictors of readmission. Readmissions (p= 0.017), renal disease (p= 0.014) and AF (p= 0.011) were predictors of mortality. Conclusion: Readmission of HF patients uses significant health care resources. Recurrent decompensated HF represents the largest cause of readmission. IHD was a predictor of readmission and readmission itself, AF and renal disease were predictors of mortality.