Rehospitalization Following Inpatient Cardiomems Implantation: Insights from the Nationwide Readmissions Database

Background : All-cause and heart failure rehospitalization are reduced following implantation of the CardioMEMS pulmonary artery pressure monitor in ambulatory patients with NYHA Class III heart failure regardless of left ventricular ejection fraction or pathogenesis who are on optimal guideline-directed therapy and have been hospitalized during the prior year. Whether device implantation in the inpatient setting is also effective is unknown. Methods : Patients who underwent inpatient CardioMEMS implantation between 2016-2018 were identified in the National Readmissions Database. Those who were transferred to or from another hospital during their index hospitalization, whose length of stay (LOS) was < 2 days, whose primary diagnosis was not for circulatory system disease, or who died were excluded. Those who underwent CardioMEMS implantation were propensity matched 5:1 to a hospitalized usual care group on 38 patient- and hospital-related factors as well as on discharge month and number of preceding admissions that year. Outcomes included all-cause (primary) and heart failure readmission at 30, 60, 90 and 180 days, inpatient LOS and cost. Results : There were 530 CardioMEMS and 2,650 usual care patients in the matched cohort. Mean age was 68 years and 37% were women. All-cause, and heart failure readmission rates were similar in the CardioMEMS and usual care cohorts at all time points (Table). Median [IQR] LOS was 8 [5,13] vs 6 [3,10] days (p=0.42), and median [IQR] cost was $48372 [$35509, $67440] vs $16415 [$8396, $38534] (p < 0.001) in the CardioMEMS and usual care groups, respectively. Conclusion Using a large US national claims dataset, we observed no difference in all-cause or heart failure readmission rates in the 6 months after index hospitalization, but significantly higher inpatient costs following inpatient CardioMEMS implantation than usual care. : All-cause and heart failure rehospitalization are reduced following implantation of the CardioMEMS pulmonary artery pressure monitor in ambulatory patients with NYHA Class III heart failure regardless of left ventricular ejection fraction or pathogenesis who are on optimal guideline-directed therapy and have been hospitalized during the prior year. Whether device implantation in the inpatient setting is also effective is unknown. : Patients who underwent inpatient CardioMEMS implantation between 2016-2018 were identified in the National Readmissions Database. Those who were transferred to or from another hospital during their index hospitalization, whose length of stay (LOS) was < 2 days, whose primary diagnosis was not for circulatory system disease, or who died were excluded. Those who underwent CardioMEMS implantation were propensity matched 5:1 to a hospitalized usual care group on 38 patient- and hospital-related factors as well as on discharge month and number of preceding admissions that year. Outcomes included all-cause (primary) and heart failure readmission at 30, 60, 90 and 180 days, inpatient LOS and cost. : There were 530 CardioMEMS and 2,650 usual care patients in the matched cohort. Mean age was 68 years and 37% were women. All-cause, and heart failure readmission rates were similar in the CardioMEMS and usual care cohorts at all time points (Table). Median [IQR] LOS was 8 [5,13] vs 6 [3,10] days (p=0.42), and median [IQR] cost was $48372 [$35509, $67440] vs $16415 [$8396, $38534] (p < 0.001) in the CardioMEMS and usual care groups, respectively. Using a large US national claims dataset, we observed no difference in all-cause or heart failure readmission rates in the 6 months after index hospitalization, but significantly higher inpatient costs following inpatient CardioMEMS implantation than usual care.