MOMENTUM 3: Newer-generation LVAD reduces hospitalization, medical costs at 2 years
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A newer-generation left ventricular assist device for patients with advanced HF reduced rehospitalizations and hospital days spent during rehospitalizations and improved cost savings after discharge at 2 years.
As previously reported by Cardiology Today , the long-term results of the MOMENTUM 3 trial, presented by Mandeep Mehra, MD, professor of medicine at Harvard Medical School and medical director of the Heart and Vascular Center at Brigham and Women’s Hospital, showed that the HeartMate 3 (HM3; Abbott) LVAD, a continuous centrifugal-flow fully magnetically levitated pump, was superior to the HeartMate II (HMII; Abbott) axial-flow pump.
Mehra and colleagues compared hospitalization and medical cost data in 361 patients from the study, of whom 337 were successfully discharged after implant, and presented the findings at Heart Failure 2018 & World Congress on Acute Heart Failure with simultaneous publication in Circulation.
“The clinical superiority of the HeartMate 3 cardiac pump is associated with a lower cost of rehospitalizations at 2 years of follow-up after implantation,” the researchers wrote in Circulation. “These findings in advanced heart failure suggest enhance cost-effectiveness of left ventricular assist systems and may allow for more widespread use across difference health care systems and geographic regions.”
The HeartMate 3 was recently the subject of a class 1 recall due to a malfunction in the device’s outflow graft assembly.
Cost was calculated using each adjudicated episode of hospital-based care, which was estimated using trial data and payer administrative claims databases.
Additionally, the researchers assessed cost savings that were stratified by subgroups.
The HM3 cohort experienced fewer total hospitalizations per patient-year (HM3, 2.1 ± 0.2; HMII, 2.7 ± 0.2; P = .015) and 8.3 fewer hospital days per patient-year on average (HM3, 17.1 days; HMII, 25.5 days; P = .003).
The researchers noted that the differences between the two cohorts were driven by patients hospitalized for suspected pump thrombosis (HM3, 0.6%; HMII, 12.5%; P < .001) and stroke (HM3, 2.8%; HMII, 11.3%; P = .002).
There was a 51% lower postdischarge cost among patients in the HM3 vs. the HMII cohort (HM3, $37,685; HMII: $76,599; P < .001); the difference was similar in patients for whom the device was destination therapy and for whom it was a bridge to transplant.
“While these early findings require confirmation in the context of larger-scale randomized trials, this important step ushers in the possibility that if demonstrated to be safe, bleeding-related complications could be decreased, such as gastrointestinal bleeds as well as hemorrhagic strokes. If this promise is proven, the technology will be even more cost-effective in the future,” the researchers wrote. “One area that remains challenging relates to the presence of exit-site drive-line infections due to the need to externally power the LVAS. A fully internalized drive-line and elimination of infection carries the promise of a greater quality of life for the patient and a further reduction in overall costs of care.” – by Dave Quaile
References:
Mehra MR, et al. Late-breaking trial III – innovative and device therapy. Presented at: Heart Failure 2018 & World Congress on Acute Heart Failure; May 26-29, 2018; Vienna.
Mehra MR, et al. Circulation. 2018;doi:10.1161/CIRCULATIONAHA.118.035722.
Disclosures: The study was funded by Abbott. Mehra reports he serves as national principal investigator for the MOMENTUM 3 study and serves as a consultant or advisory board member for Bayer, Janssen, Medtronic, Mesoblast, NuPulse CV and Portola.