Long-term Outcomes and Costs of Ventricular Assist Devices Among Medicare Beneficiaries

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Abstract
Mechanical circulatory support with a ventricular assist device is an evolving technology for patients with end-stage heart failure. Ventricular assist devices may be considered in several clinical scenarios but are used principally in patients with end-stage heart failure who are awaiting heart transplantation, as “destination,” or permanent, therapy for patients who are not candidates for transplantation, or as a rescue procedure for patients with refractory shock after open-heart surgery.1-3 Clinical scenarios for ventricular assist devices often involve patients with rapidly deteriorating conditions for which an assist device is considered emergent because of imminent death or urgent because of end-organ dysfunction. The Randomized Evaluation of Mechanical Assistance in the Treatment of Congestive Heart Failure (REMATCH) demonstrated that destination therapy with an assist device could reduce mortality by 48% among patients with end-stage heart failure and improve quality of life.4 However, overall survival in REMATCH was poor among patients who received an assist device, with 52% surviving after 1 year and 23% surviving after 2 years.