By: James Pitt  May. 14, 2018
Ventricular assist devices (VADs) are implantable pumps used to support heart function. VADs are most frequently used for left-sided heart failure (LVADs). There were experiments with air-powered VADs as early as 1963, but first-generation electric VADs were not available until the FDA approved the ThoraTec HeartMate I in 1995.
LVADs are particularly relevant for heart failure with reduced ejection fraction (HFrEF), in which the left ventricle cannot contract with enough force. Mancini and Colombo (2015) reviewed the treatment of patients with HFrEF in Stage D heart failure in Journal of the American College of Cardiologists. The author posit that “In the future, VADs may be considered initial therapy for Stage D HF, with heart transplant reserved for VAD failures and selected patients.” Current practice is to consider such patients for a heart transplant, and implant a VAD if they do not qualify.
Hearteningly, a 2015 study of 208 patients in American Journal of Cardiology found that LVAD was noninferior to cardiac transplantation in patients who would not normally qualify for heart transplants. The 2-year mortality estimate was lower for the patients who received continuous flow LVADs (11.2%) than for patients who received heart transplants (27.3%), though the 95% confidence intervals overlapped.
To examine the need for LVADs, Dexur analysts used 2013-2016 data from the ten US hospitals with the most CMS inpatient discharges for DRG 001 (Heart Transplant Or Implant Of Heart Assist System With Major Complications or Comorbidities).
These hospitals are spread out across the US, and their proportions of HFrEF patients vary widely. At Duke University Health System (Durham, NC), 85% of patients discharged with DRG 001 had HFrEF. But at Barnes-Jewish Hospital (St. Louis, MO), only 30% of patients discharged with DRG 001 had HFrEF.
Therefore, the need for LVADs must be assessed locally, not just nationally. Continuous flow LVADs such as Thoratec’s HeartMate II (currently the most-used LVAD; the manufacturer claims 25,000 patients as of 2018) have allowed some patients to live over a decade. Because LVADs are the most-used type of VAD, hospitals with a high proportion of HFrEF patients may have a particular opportunity.