Emergency department use and hospital admissions among adult orthotopic heart transplant patients

Abstract

Objective To study the demographics, clinical presentations, and outcomes of emergency department (ED) visits of patients with heart transplantation (HT) in the United States. Methods We performed a secondary analysis of the National Emergency Department Sample database from 2016 to 2018. All ED visits of patients with HT aged ≥ 18 years were identified using International Classification of Diseases, Tenth Revision codes. Results Out of a total 308,182,495 national ED visits, 55,583 were HT‐related visits. The median age was 61.07 years (interquartile range [IQR]: 46.91–69.38) and 69.44% were males. The hospital admission rate was 54.3% and median inpatient length of stay was 3.19 days (IQR: 1.63–5.92). The mortality rate during inpatient stay was 1.16%. Median inpatient and ED charges among admitted patients were $37,911 (IQR: $21,487–$71,262). The most common primary diagnosis of HT‐related ED visits was sepsis (4.3%) followed by acute kidney injury (3.57%) and chest pain (3%). Conclusion More than half of total ED visits among HT patients resulted in hospital admission. The most common cause for ED visit in these patients was sepsis followed by acute kidney injury and chest pain.

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

“…In our analysis, as in the study by Pothuru et al, 7 most ED encounters were for noncardiac conditions, with infection being most common, which reinforces prior findings and has important implications. Infection has been shown to be a leading cause of morbidity and consequently readmission after transplant 12 , and prior studies of smaller cohorts have shown that infection is the most common reason for patients with HTs to present to the ED.…”

“…The most common cause for presentation was sepsis, followed by acute kidney injury and chest pain. 7 Our work confirms and adds to these findings in a much larger, and longitudinal, cohort of patients.…”

“…The NEDS database has been previously used to describe ED use in left ventricular assist device patients 23 , 24 and in a more limited analysis of HT recipients. 7 These prior studies, as our current study, have the limitations applicable to retrospective designs and database analyses. We used ICD‐9‐CM and ICD‐10‐CM codes assigned at time of the ED encounter and thus could be including misdiagnosed or miscoded cases.…”

“…We now confirm that admission rates for HT recipients were much higher compared with those of the general population, with nearly half of all ED encounters leading to an inpatient stay compared with 14% to 20% in the overall general population. 4 , 7 , 11 , 17 Interestingly, length of stay was relatively short at just >3 days, and the mortality rate was comparatively low at <2%. Furthermore, we found that the diagnoses that most strongly predicted admission differed from those associated with mortality.…”