Sex Differences in Left Ventricular Assist Device-related Emergency Department Encounters in the United States

Reza, Nosheen; Edwards, Janice G.; Katcoff, Hannah; Mondal, Antara; Griffis, Heather; Rossano, Joseph W.; Lin, Kimberly Y.; Holzhauser, H. Luise; Wald, Joyce; Owens, Anjali Tiku; Cappola, Thomas P.; Birati, Edo Y.; Edelson, Jonathan B.

doi:10.1016/j.cardfail.2022.05.005

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…[8][9][10] Previous studies assessing the sex-associated differences in the clinical outcomes of LVAD recipients have shown inconsistent results. 8,11,12 The sexassociated differences in clinical outcomes may be perpetuated by differences in social (race and ethnicity) and clinical factors (implantation center volume and device strategy) known to impact clinical outcomes in LVAD recipients. 11,[13][14][15][16][17][18][19] However, a comprehensive investigation of the impact of these social and clinical factors on sex-associated differences in post-LVAD outcomes is not known.…”

mentioning

confidence: 99%

Sex-Associated Differences in the Clinical Outcomes of Left Ventricular Assist Device Recipients: Insights From Interagency Registry for Mechanically Assisted Circulatory Support

Shetty

Parcha

Abdelmessih

et al. 2023

Circ: Heart Failure

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Background: Sex-associated differences in clinical outcomes among left ventricular assist device recipients in the United States have been recognized. However, an investigation of the social and clinical determinants of sex-associated differences is lacking. Methods: Left ventricular assist device receiving patients enrolled in Interagency Registry for Mechanically Assisted Circulatory Support between 2005 and 2017 were included. The primary outcome was all-cause mortality. Secondary outcomes included heart transplantation and postimplantation adverse event rates. The cohort was stratified by the social subgroup of race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic), and clinical subgroups of device strategy (destination therapy, bridge to transplant, and bridge to candidacy), and implantation center volume (low [≤20 implants/y], medium [21–30 implants/y], and high [>30 implants/y]). A multivariable-adjusted Cox proportional hazard model was used to assess the risk of death and heart transplantation with prespecified interaction testing. Poisson regression was used to estimate adverse events by sex across the various subgroups. Results: Among 18 525 patients, there were 3968 (21.4%) females. Compared with their male counterparts, Hispanic (adjusted hazard ratio [HR adj ], 1.75 [1.23–2.47]) females had the highest risk of death followed by non-Hispanic White females (HR adj , 1.15 [1.07–1.25]; P interaction =0.02). Hispanic (HR adj , 0.60 [0.40–0.89]) females had the lowest cumulative incidence of heart transplantation followed by non-Hispanic Black females (HR adj , 0.76 [0.67–0.86]), and non-Hispanic White females (HR adj , 0.88 [0.80–0.96]) compared with their male counterparts ( P interaction <0.001). Compared with their male counterparts, females on the bridge to candidacy strategy (HR adj , 1.32 [1.18–1.48]) had the highest risk of death ( P interaction =0.01). The risk of death ( P interaction =0.44) and cumulative incidence of heart transplantation ( P interaction =0.40) did not vary by sex in the center volume subgroup. A higher incidence rate of adverse events after left ventricular assist device implantation was also seen in females compared with the males, overall, and across all subgroups. Conclusions: Among left ventricular assist device recipients, the risk of death, the cumulative incidence of heart transplantation, and adverse events differ by sex across the social and clinical subgroups.

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mentioning

confidence: 99%

Sex-Associated Differences in the Clinical Outcomes of Left Ventricular Assist Device Recipients: Insights From Interagency Registry for Mechanically Assisted Circulatory Support

Shetty

Parcha

Abdelmessih

et al. 2023

Circ: Heart Failure

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…As in prior NEDS publications, 23 , 24 comorbidities were prespecified and obtained from ICD‐9‐CM and ICD‐10‐CM codes in the diagnoses and procedure group files as well as the inpatient records. Thus, we cannot rule out that there could be coding differences between those admitted to the hospital versus those discharged from the ED.…”

Section: Discussionmentioning

confidence: 99%

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

Holzhauser,

Reza,

Edwards

et al. 2024

JAHA

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Background Annual heart transplant (HT) volumes have increased, as have post‐HT outpatient care needs. Data on HT‐related emergency department (ED) visits are limited. Methods and Results A retrospective analysis of 177 450 HT patient ED visits from the 2009 to 2018 Nationwide Emergency Department Sample was conducted. HT recipients, primary diagnoses, and comorbidities associated with ED visits were identified via International Classification of Diseases, Ninth Revision ( ICD‐9 ) and International Classification of Diseases, Tenth Revision ( ICD‐10 ) codes. Multivariable logistic regression was used to predict outcomes of hospital admission and death. HT volumes and HT‐related ED visits increased from 2009 to 2018. Infection was the most common primary diagnosis (24%), and cardiac primary diagnoses represented 10% of encounters. Hospital admissions occurred in 48% of visits, but overall mortality was low (1.6%). Length of stay was 3.1 days (interquartile range, 1.6–5.9 days), and comorbidity burden was high: 42% had hypertension, 38% had diabetes, and 31% had ≥2 comorbidities. Those aged ≥65 years had significantly higher odds of admission (odds ratio [OR], 2.14 [95% CI, 1.97–2.33]) and death (OR, 2.06 [95% CI, 1.61–2.62]). Comorbidities increased odds of admission (OR, 1.62 [95% CI, 1.51–1.75]) but not death. Renal primary diagnosis had the highest risk of admission (OR, 4.1 [95% CI, 3.6–4.6]), but cardiac primary diagnosis had the highest odds of death (OR, 11.6 [95% CI, 9.1–14.8]). Conclusions HT‐related ED visits increased from 2009 to 2018 with high admission rates but low in‐hospital mortality, suggesting an opportunity to improve prehospital care. Older patients and those with cardiac primary diagnoses 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 and outpatient care strategies.

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“…From 2010-2018, the United States had 57,200 emergency room encounters for adult patients with LVADs. 5 Complications related to VADs, such as infection or right ventricular failure, were common and associated with increased risk of admission in pediatric and young adult populations. 6,7 These findings have shaped guidelines in emergency medicine, focusing on early recognition of VAD complications and early involvement of and communication with the VAD team.…”

Section: Introductionmentioning

confidence: 99%

Emergency Medical Services Protocols for Assessment and Treatment of Patients with Ventricular Assist Devices

Larson,

Woo,

Moon

et al. 2024

Prehosp. Disaster med.

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Background: Patients with ventricular assist devices (VADs) represent a growing population presenting to Emergency Medical Services (EMS), but little is known about their prehospital care. This study aimed to characterize current EMS protocols in the United States for patients with VADs. Methods: States with state-wide EMS protocols were included. Protocols were obtained from the state EMS website. If not available, the office of the state medical director was contacted. For each state, protocols were analyzed for patient and VAD assessment and treatment variables. Results: Of 32 states with state-wide EMS protocols, 21 had VAD-specific protocols. With 17 (81%) states noting a pulse may not be palpable, protocols recommended assessing alternate measures of perfusion and mean arterial pressure (MAP; 15 [71%]). Assessment of VAD was advised through listening for pump hum (20 [95%]) and alarms (20 [95%]) and checking the power supply (15 [71%]). For treatment, EMS prehospital consultation was required to begin chest compression in three (14%) states, and mechanical (device) chest compressions were not permitted in two (10%) states. Contact information for VAD coordinator was listed in a minority of five (24%) states. Transport of VAD equipment/backup bag was advised in 18 (86%) states. Discussion: This national analysis of EMS protocols found VAD-specific EMS protocols are not universally adopted in the United States and are variable when implemented, highlighting a need for VAD teams to partner with EMS agencies to inform standardized protocols that optimize these patients’ care.

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Sex Differences in Left Ventricular Assist Device-related Emergency Department Encounters in the United States

Cited by 5 publications

References 29 publications

Sex-Associated Differences in the Clinical Outcomes of Left Ventricular Assist Device Recipients: Insights From Interagency Registry for Mechanically Assisted Circulatory Support

Sex-Associated Differences in the Clinical Outcomes of Left Ventricular Assist Device Recipients: Insights From Interagency Registry for Mechanically Assisted Circulatory Support

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

Emergency Medical Services Protocols for Assessment and Treatment of Patients with Ventricular Assist Devices

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