Trends in Emergency Department Use and Hospital Mortality Among Heart Transplant Recipients in the United States

Abstract

<h3>Purpose</h3> Annual heart transplant (HT) volume and post-HT outpatient care needs have increased over the last decade. However, contemporary data on the characteristics and outcomes of HT-related emergency department (ED) visits are limited. <h3>Methods</h3> Retrospective analysis of 177,450 HT patient ED visits from the 2009-2018 Nationwide Emergency Department Sample. HT recipients, primary diagnoses (PD) and comorbidities (CM) associated with ED visits were identified via ICD-9/10 codes. Multivariable logistic regression was used to predict outcomes of hospital admission and death. <h3>Results</h3> HT volumes and HT-related ED visits increased during the observed period (Fig. A). Median age was 61 years (IQR 46,69); 70% male. CM burden was high: 38% diabetes, 42% hypertension, and 31% > 2 CM. Infectious complications were the most common PD (24%) whereas cardiac PD represented 10% of encounters. 48% of ED visits led to hospital admissions, but overall mortality was low (1.6%). Median length of stay was 3 days (IQR 1.6,5.9), with overall charge $13,304 (IQR 3,868; 37,422). Those aged ≥ 65 years had a significantly higher odds of admission (OR 2.14, 95% CI 1.97,2.33) and death (OR 2.06, 95% CI 1.61,2.62; both p<0.001). The number of CM increased odds of admission (OR 2.16, 95% CI 1.97,2.37; p<0.001) but not death (Fig. B). The highest risk of admission was seen with renal PD (OR 4.05, 95% CI 3.6,4.57) followed by infection and stroke. In contrast, HT recipients presenting with cardiac PD had the highest odds of death (OR 11.6, 95% CI 9.09,14.85; both p <0.001) (Fig. C). <h3>Conclusion</h3> The burden of HT-related ED visits increased from 2009-2018 and was characterized by a high admission rate but low in-ED and hospital mortality, suggesting an opportunity to improve pre-hospital care. Older patients and those presenting with cardiac PD had the highest risk of death. The observed contrast between predictors of admission and mortality signals a need for further study to improve risk stratification for HT recipients presenting to the ED.