Abstract 13997: Thirty-Day Readmissions Rates and Causes Among Patients After Heart Transplant: Insights From the Nationwide Readmissions Database

Abstract

Introduction: Heart transplantation (HT) is a treatment of choice for many patients with advanced heart failure who continue to deteriorate despite optimal medical therapy. Data on patient characteristics, predictors, and readmission rates after HT is limited. We sought to evaluate the causes and predictors of the 30-day readmission rate among HT patients. Methods: Using the Nationwide Readmission Database, we included adult patients (≥18 years old) who underwent HT between January 2016 to November 2018. Patients with dual organ transplants were excluded from the study. Thirty-day readmission rates, causes, and predictors of readmission were assessed. Results: We analyzed 7386 patients who underwent HT and discharged alive during the years 2016 to 2018. The mean age was 53.35 ± 12.97 years and 73% were males. The 30-day readmission rate was 22.4% (n=1647). Heart transplant rejection/failure was the main cause of readmission (16.3%) followed by systemic infections (13.2%), post-procedure transplant complications (10%), acute kidney injury (6.3%), and procedure-related wound infection (4.2%) (Fig 1A) . Using multivariate logistic regression the risk of 30-day readmission was higher in patients with high comorbidity burden if Elixhauser score > 14 (OR 1.41: 95% CI 1.10-1.79) and in patients who have a length of stay > 30 days during index admission (OR 1.18: 95% CI 1.01-1.39). Female gender was also found to be an independent predictor of readmission (OR 1.33: 95% CI 1.09-1.61) (Fig 1B) . Conclusions: Readmission rate is high in orthotopic heart transplant patients and is driven mostly by graft rejection/failure, infections, and post-procedure-related complications. Pre-transplant identification of high-risk patients will help in improving outcomes.