Clinical Impact of Heart Failure Readmissions in HeartMate 3 Left Ventricular Assist Device Recipients

Heart failure (HF) readmissions remain common and adversely affect morbidity and quality of life in durable left ventricular assist device (LVAD) recipients. This study sought to describe the clinical impact of HF readmissions following HeartMate 3 (HM3) LVAD implantation. We conducted a single-center analysis of patients undergoing HM3 implantation between January 2015 and December 2021. Cumulative incidence functions were used to estimate HF readmission, and multistate models evaluated transitions from LVAD implantation to recurrent HF readmissions and death. Among 273 patients with HM3 implantation, the mean age was 58 years, 75% were men, and 78% were Black. Overall, 78 patients (29%) experienced at least one HF readmission. Preimplant diabetes mellitus and higher body mass index were significant predictors of HF readmission. Heart failure readmissions occurred more frequently than death throughout follow-up (1 year: 20.8% vs. 8.5%; 4 years: 30.5% vs. 23.4%). Readmissions were highly recurrent, and mortality risk increased with each additional HF readmission (4 year adjusted mortality: 31.2% and 39.3% after the first and second HF readmission, respectively). Heart failure readmissions remain a major source of morbidity among HM3 LVAD recipients. Recurrent readmissions are associated with a stepwise increase in mortality and these findings underscore the need for targeted strategies to prevent recurrent HF readmissions in this population.