We described LVAD utilization and outcomes among Medicare beneficiaries after
ESRD onset (defined as having received maintenance dialysis or a kidney transplant) from 2003 to 2013 based on Medicare claims linked to data from the United States Renal Data System (USRDS), a national registry for
ESRD. We compared Medicare beneficiaries with
ESRD to a 5% sample of Medicare beneficiaries without
ESRD.
Exposures: The primary outcome was survival after LVAD placement.
Results: Among the patients with
ESRD, the mean age was 58.4 (12.1) years and 62.0% (96) were male. Among those without
ESRD, the mean age was 62.2 (12.6) years and 75.1% (196) were male. From 2003 to 2013, 155 Medicare beneficiaries with
ESRD (median and interquartile range [IQR] days from
ESRD onset to LVAD placement were 1655 days [453-3050 days]) and 261 beneficiaries without
ESRD in the Medicare 5% sample received an LVAD. During a median follow-up of 762 days (IQR, 92-3850 days), 127 patients (81.9%) with and 95 (36.4%) without
ESRD died. more than half of patients with
ESRD (80 [51.6%]) compared with 11 (4%) of those without
ESRD died during the index hospitalization. The median time to death was 16 days (IQR 2-447 days) for patients with
ESRD compared with 2125 days (IQR, 565-3850 days) for those without
ESRD. With adjustment for demographics, comorbidity and time period, patients with
ESRD had a markedly increased adjusted risk of death (hazard ratio, 36.3; 95% CI, 15.6-84.5), especially in the first 60 days after LVAD placement.
Conclusions and Relevance: