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April 22 2009

Outcomes of Medicare Beneficiaries With Ventricular Assist Devices

JAMA. 2009;301(16):1656-1658. doi:10.1001/jama.2009.525

To the Editor: The study by Dr Hernandez and colleagues1 reported on outcomes of ventricular assist device recipients by analyzing claims from the Centers for Medicare & Medicaid Services from 2000 to 2006. They reported a 1-year survival of 51.6% for the primary device group and 30.8% for the postcardiotomy group. Given the introductory comments as well as numerous references to the REMATCH trial2 and the 50% 2-year survival benchmark set by the National Heart, Lung, and Blood Institute Working Group for destination therapy (the use of ventricular assist devices in patients who are not candidates for cardiac transplantation),3 we are concerned that this analysis does not represent the current state of destination therapy in the Medicare population. As the authors state in their limitations section, their analysis reflects the use of a large variety of devices ranging from percutaneous external devices to long-term implantable devices used for destination therapy. We do not believe it appropriate to compare a short-term percutaneous ventricular assist device inserted for 6 hours as backup for high-risk angioplasty with a long-term implantable destination therapy device.