Relationship between Length of Hospital Stay Post LVAD Implant and Survival: The Potential for Understanding a Less Sick Population

Purpose The ENDURANCE and ENDURANCE Supplemental Trials were designed to study the safety and efficacy of the HeartWare LVAD (HVAD) to support patients with advanced heart failure ineligible for transplant compared to the control HM2 device. There is increasing interest in the “less sick” patient with advanced heart failure. It is reasonable to assume that the total length of post-implant hospital stay would be correlated with less perioperative morbidity. Methods The ENDURANCE Trial prospectively randomized 465 patients with advanced heart failure to receive the HVAD (N=296) or the HM2 Control (n=149), and the ENDURANCE Supplemental Trial prospectively enrolled 465 patients (308 HVAD versus 157 control, HM2) with added improved blood pressure management. Data from these trials supported the FDA approval of the HVAD System for destination therapy in advanced heart failure patients. We now present a retrospective analysis of the total length of hospital stay (LOS) following LVAD implant. We separated the patients into 3 groups based on their total hospital stay, and performed Kaplan-Meier analysis as well as freedom from major LVAD-related adverse events over the 24 months post-implant Results There was an inverse relationship between total length of post-implant LOS and survival (p Conclusion The finding that total length of post-implant hospital stay is inversely related to survival is important especially considering the lack of difference in the freedom from bleeding, infection, stroke, and thrombotic events in these subgroups. These data suggest that LOS and subsequent survival is not necessarily related to VAD-related complications, but perhaps to underlying patient baseline condition.