Comparing Resource Use and Outcomes between Patients with Ventricular Assist Devices and Orthotopic Heart Transplant in the United States from 2006-2014: A Nationally Representative Sample of Emergency Department Visits

Abstract

With advances in mechanical circulatory support and orthotopic heart transplants (OHT) remaining a limited resource, there has been a dramatic increase in Ventricular Assist Device (VAD) implantation. There is minimal data comparing emergency department (ED) resource utilization and outcomes between these populations. We examined national estimates of VAD and OHT-related ED visits and evaluated admissions, resource utilization, and mortality. This study is an epidemiological analysis comparing national estimates of ED visit-level data from the 2006-2014 Nationwide Emergency Department Sample (NEDS) in patients with VADs vs OHT, identified using ICD-9 codes. The primary outcome was death; secondary outcomes included median inflation-adjusted charge and hospital admission. We tested the hypothesis that resource utilization and mortality are higher in ED visits for VAD patients compared to OHT patients. 17,356 VAD-related ED, and 138,133 OHT-related visits were identified. Patients with VADs were more likely to be male (74% vs 70%, p=0.001) and ≥ 65 yo (39% vs 38%, p=0.0004). VADs were more likely to have a primary diagnosis of bleeding (25% vs 2%) and less likely to have acute respiratory disease (6% vs 20%, p<0.0001 for both). VAD-related ED visits had higher rates of inpatient admission or transfer (73% vs 57%) and a higher mortality rate (4.7% vs 1.8%) than patients with OHT (p <0.0001 for all). Moreover, VAD related ED visits had higher median inflation-adjusted charges [$23,862 (IQR $7,129-$58,265) vs $11,364 (IQR $3,001-$31,694)] (p<0.0001). Patients with VADs presenting to the ED represent a population with greater morbidity, mortality and resource utilization compared to OHT. A more developed understanding of those factors that drive mortality and resource use is imperative for improving outcomes in this high-risk population.