Hospitalisation and life support in the year before and during heart transplantation: a French national study.

OBJECTIVE

The objective of this study was to define the characteristics of hospital care use during the year prior to heart transplantation.

METHODS

A retrospective cohort of heart transplant recipients registered on the national hospital discharge database between 2010 and 2015 was analysed.

RESULTS

In this cohort of 2379 heart transplant recipients (mean age: 48 years, 74% men), 91% had been admitted at least once, for at least 1 day, to a short-stay hospital during the year before transplantation (mean: 4.3 days), and 84% had at least one cardiovascular diagnosis (heart failure and cardiogenic shock: 60%). At least one intensive care stay was reported for 61% of patients, a rehabilitation stay was reported for 30%, mechanical circulatory support was reported for 12%, and ventilatory support was reported for 15%. The median interval between admission and transplantation was 5 days (interquartile QI-Q3, 0-16). The hospital mortality was higher for patients not hospitalised before transplantation (18% vs 15%). Their transplantation hospitalisation diagnosis, compared with patients hospitalised before transplantation, was more frequently cardiomyopathy (31% vs 27%) or heart failure (28% vs 18%), and less frequently myocardial infarction (1% vs 12%).

CONCLUSION

This study demonstrates a high hospitalisation rate before heart transplantation and identifies three groups of patients: 1-patients with a high hospitalisation rate and terminal heart failure requiring circulatory support who experienced at least one intensive care unit stay; 2-patients with a history of hospitalisation, mainly for heart disease, without circulatory support requirement; and 3-patients with no pretransplantation overnight stay. These findings provide useful information to evaluate the medical benefits and needs for transplantation, and identify areas for improvement in heart transplantation listing criteria.