Division of Cardiovascular Medicine, Department of Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.
Division of Cardiology, Cardiac Center, the Childrens Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.
J Am Heart Assoc. 2024 Mar 5;13(5):e032676. doi: 10.1161/JAHA.123.032676. Epub 2024 Feb 29.
Annual heart transplant (HT) volumes have increased, as have post-HT outpatient care needs. Data on HT-related emergency department (ED) visits are limited.
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 () and () 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]).
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.
每年的心脏移植（HT）数量有所增加，同时 HT 门诊护理需求也有所增加。关于 HT 相关急诊部（ED）就诊的数据有限。
对 2009 年至 2018 年全国急诊部样本中 177450 例 HT 患者 ED 就诊进行回顾性分析。通过 () 和 () 代码确定 HT 受者、主要诊断和与 ED 就诊相关的合并症。多变量逻辑回归用于预测住院和死亡的结局。HT 数量和 HT 相关 ED 就诊从 2009 年到 2018 年增加。感染是最常见的主要诊断（24%），而心脏主要诊断占就诊的 10%。48%的就诊需要住院治疗，但总体死亡率较低（1.6%）。住院时间为 3.1 天（四分位间距，1.6-5.9 天），合并症负担较重：42%有高血压，38%有糖尿病，31%有≥2 种合并症。年龄≥65 岁的患者住院治疗的可能性显著增加（比值比[OR]，2.14 [95%可信区间，1.97-2.33]）和死亡（OR，2.06 [95%可信区间，1.61-2.62]）。合并症增加了住院治疗的可能性（OR，1.62 [95%可信区间，1.51-1.75]），但不会增加死亡的可能性。肾脏的主要诊断有最高的住院治疗风险（OR，4.1 [95%可信区间，3.6-4.6]），但心脏的主要诊断有最高的死亡风险（OR，11.6 [95%可信区间，9.1-14.8]）。
HT 相关 ED 就诊从 2009 年到 2018 年有所增加，住院率较高，但院内死亡率较低，这表明有机会改善院前护理。年龄较大的患者和心脏主要诊断患者的死亡风险最高。入院和死亡的预测因素之间的明显对比表明，需要进一步研究以改善风险分层和门诊护理策略。
