Abstract 15760: Survival Following Durable Ventricular Assist Device Implantation is Associated With Provider Teamwork: A Social Network Analysis

Introduction: Health systems with more robust provider teamwork have lower mortality rates for coronary artery bypass grafting. Patients undergoing durable ventricular assist device (VAD) therapy have complex comorbidities and develop adverse events requiring multidisciplinary provider teamwork. Hypothesis: Provider teamwork is associated with 180-day mortality following durable VAD implantation. Methods: Data (linked Medicare claims+INTERMACS) were analyzed from primary durable VADs implanted across 119 hospitals over a five-year period. Claims were used to identify provider interactions (cardiac surgeons, cardiologists, anesthesiologists, intensivists, nurse practitioners, physician assistants) for previously shared VAD patients during the 1-year period ending 6-months before each patient’s VAD implant admission. Provider teamwork was assessed at the hospital level using a clustering coefficient (range: 0-1; higher values = greater teamwork), an established and validated measure capturing the prevalence of tightly connected groups in a network. Provider teamwork level was associated with a patient’s 180-day mortality rate using multivariable regression adjusting for baseline characteristics reported to INTERMACS. Results: The study cohort included 2,807 VAD patients (mean age 63 years, 53% for destination therapy, 19% female, 74% white) with 10.8% identified as INTERMACS Profile 1. There were 468 deaths (16.7%) within 180 days of implantation. Provider teamwork (clustering coefficient) was inversely associated with 180-day mortality (beta=-0.79; 95%CI: -1.26, -0.11). A 1SD increase in provider teamwork was associated with a 13.4% decrease in the predicted probability of 180-day mortality, Figure. Conclusions: Social networks characterized by greater provider teamwork are important determinants of mortality following VAD implantation and may serve as targets for optimizing outcomes and greater adoption for this therapy.