Abstract 141: Trends in Left Ventricle Assist Device Use, Outcomes and Costs among Medicare Beneficiaries, 1999 to 2008.

Background: Over the last decade, left ventricle assist device (LVAD) technology has improved substantially, resulting in smaller devices requiring less invasive procedures, which has broadened its clinical indications to frail populations. During this time of technological advancement, we examined trends in use, mortality, and associated costs of LVADs among Medicare beneficiaries. Methods: Inpatient Medicare standard analytic files were used to identify 100% of fee-for-service (FFS) patients aged ≥65 years that received LVAD (ICD-9-CM codes 37.60, 37.62, 37.65, 37.66 and 37.68) from 1999 to 2008. We constructed a denominator file from Medicare administrative data to report operative rates per 1,000,000 beneficiary-years. Length of stay, hospital mortality, thirty-day and one-year mortality were ascertained through corresponding vital status files. Costs were defined as hospital payments made by Medicare. Results: Among Medicare FFS patients, the overall LVAD procedure rate increased from 13.8 per million beneficiary-years (365 procedures) in 1999 to 19.8 per million beneficiary-years (548 procedures) in 2008, a relative increase of 44 %. In addition, between 1999 and 2008 overall length of stay increased from 19.1 days to 23.8 days; hospital mortality decreased from 42.5% to 33.4%, 30-day mortality decreased from 38.9% to 30.7% and one-year mortality decreased from 54% to 47.1%. Total CMS payments for the hospitalizations in which LVADs were placed increased from $20,188,880 ($55,312/patient) in 1999 to $71,050,392 ($129,654/patient) in 2008. Over the study period, LVAD use increased in all age groups, most strikingly among the ≥75 years old, in whom incidence increased from 151 procedures in 1999 to 192 procedures in 2008, representing 35% of the LVAD implantation in the Medicare population in 2008. Conclusions: From 1999 to 2008, LVAD use increased substantially with a decrease in hospital, 30-day and one-year mortality.