In a nationwide registry analysis, approximately 15% of days remained lost annually after the first year following durable LVAD implantation, emphasizing the need for improved chronic-phase management and targeted prevention of key complications.
Key Findings
Results
Mean days alive and out of hospital (DAOH) improved after the first year but remained substantially below the maximum possible days across all three years post-LVAD implantation.
Mean DAOH was 216 days during the first year (days 1–365)
Mean DAOH was 309 days during the second year (days 366–730)
Mean DAOH was 303 days during the third year (days 731–1095)
Approximately 15% of days remained lost annually after the first year
Sample sizes were n=1379 for year 1, n=1136 for year 2, and n=895 for year 3
Results
The primary driver of days lost shifted from initial LVAD implantation hospitalization in year one to other hospitalizations in subsequent years.
During days 1 to 365, most days lost were attributable to the initial hospitalization for LVAD implantation
In the second and third years (days 366–730 and 731–1095), other hospitalizations became the main contributors to days lost
This shift highlights the growing burden of recurrent hospitalization in the chronic phase after LVAD implantation
Results
Older age and impaired renal function were associated with shorter DAOH during the first 365 days post-implantation.
Older age was identified as a factor associated with fewer DAOH in year 1
Impaired renal function was also associated with shorter DAOH during the first year
These associations were specific to the first postimplantation interval (days 1–365)
Data were drawn from the J-MACS registry covering implantations between 2010 and 2023
Results
Lower INTERMACS profile and implantation in an earlier era were consistently associated with shorter DAOH across all three time intervals.
A lower INTERMACS profile (indicating more severe hemodynamic compromise at implantation) was associated with shorter DAOH in years 1, 2, and 3
Implantation in the earlier era was also consistently associated with shorter DAOH across all three intervals
These were the only two factors that showed consistent association with DAOH across all three time periods studied
Results
Infection (particularly pump-related infection) and neurological dysfunction were the major contributors to hospitalization-related days lost after discharge from the initial hospitalization.
These complications were the leading causes of days lost due to hospitalization across all three time intervals
Pump-related infection was specifically identified as a key subtype of infection driving hospitalization burden
Neurological dysfunction was consistently among the top contributors to hospitalization-related days lost in all time intervals
These findings were identified from the J-MACS registry of patients undergoing durable LVAD implantation between 2010 and 2023
Methods
The study used the J-MACS (Japanese Registry for Mechanically Assisted Circulatory Support) registry to evaluate DAOH as a patient-centered composite outcome metric in LVAD recipients.
Patients who underwent durable LVAD implantation between 2010 and 2023 were analyzed
DAOH and days lost due to death and hospitalization were evaluated across three postimplantation intervals: days 1–365, 366–730, and 731–1095
DAOH is described as 'a patient-centered metric that reflects both survival and hospitalization burden'
This represents a nationwide registry analysis, and data using this measure in LVAD populations are described as limited
What This Means
This research examined how many days patients with advanced heart failure were actually alive and out of the hospital after receiving a durable left ventricular assist device (LVAD) — a mechanical pump implanted to help a failing heart. Using data from a large Japanese national registry of over 1,300 patients implanted between 2010 and 2023, the researchers tracked 'days alive and out of hospital' (DAOH) across three consecutive one-year periods following surgery. They found that in the first year, patients averaged only 216 days out of the hospital — largely because the implant surgery itself requires a lengthy hospital stay. In years two and three, patients did better, averaging around 303–309 days at home, but still lost roughly 15% of days each year to hospitalization or death.
The study found that after the initial recovery period, repeat hospitalizations — rather than death — became the main reason patients were losing days. The biggest culprits were infections (especially infections related to the LVAD pump itself) and neurological complications such as stroke. Patients who were sicker at the time of implantation (indicated by a lower INTERMACS profile score) and those who received their devices in earlier years consistently had fewer days at home across all three years. In the first year specifically, older patients and those with worse kidney function also tended to spend more time hospitalized.
This research suggests that while LVADs meaningfully extend and improve life for people with severe heart failure, a substantial portion of that life is still spent in the hospital, particularly due to preventable complications like device-related infections. The findings highlight an opportunity to improve outcomes not just by refining the surgery itself, but by focusing on long-term management strategies — including better infection prevention and monitoring for neurological events — to help patients spend more time at home after their devices are implanted.
Kondo T, Kazama S, Imaizumi T, Nagai S, Nozaki A, Komeyama S, et al.. (2026). Short- and Long-Term Days Alive and Out of Hospital After Left Ventricular Assist Device Implantation.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.048338