Driggin Elissa, Lemos Carolina, Bidani Shruti, Vargas Fabian, Batra Jaya, Donald Elena, Latif Farhana, Uriel Nir, Sayer Gabriel, Clerkin Kevin, DeFilippis Ersilia M
Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
Clin Transplant. 2025 Jul;39(7):e70193. doi: 10.1111/ctr.70193.
Days alive and out of the hospital (DAOH) is an increasingly used patient-centered outcome in studies of patients with heart failure, but has not been well studied in heart transplantation (HT). We sought to examine predictors of DAOH at 1-year post-discharge from HT in a diverse population at a large volume HT center.
Adult recipients who underwent HT between January 1, 2005 and December 31, 2022 at our institution were included. Baseline demographics were collected as well as psychosocial factors including primary insurance, education, primary language, and socioeconomic status (SES) index as determined by the American Community Survey using patient zip code data. The primary outcome was DAOH at 1 year from HT, accounting for hospital readmissions and time spent in rehabilitation facilities. For patients who died on index admission, DAOH was considered 0.
A total of 1141 patients (26% female, 16% Hispanic, 24% Black) were included in the primary analysis. Seventy-two patients (6.3%) died during the index HT hospitalization. Mean DAOH was 306 (± 87) days. Among those who survived to hospital discharge, 56% were readmitted at least once in the first year after HT. After adjustment for clinical and psychosocial variables, older age, chronic kidney disease, post-2018 allocation change, and greater length of stay at the index hospitalization were associated with significantly fewer DAOH.
The integration of patient-centered metrics such as DAOH should be a continued priority in our transplant community as it may better convey health-related quality of life.
存活出院天数（DAOH）在心力衰竭患者研究中作为以患者为中心的结局指标使用得越来越多，但在心脏移植（HT）中尚未得到充分研究。我们试图在一家大型心脏移植中心的不同人群中，研究心脏移植术后1年出院时存活出院天数的预测因素。
纳入2005年1月1日至2022年12月31日在我们机构接受心脏移植的成年受者。收集基线人口统计学数据以及社会心理因素，包括主要保险、教育程度、主要语言以及根据美国社区调查使用患者邮政编码数据确定的社会经济地位（SES）指数。主要结局是心脏移植术后1年的存活出院天数，包括再次入院和在康复机构的停留时间。对于在首次入院时死亡的患者，存活出院天数视为0天。
共有1141例患者（26%为女性，16%为西班牙裔，24%为黑人）纳入主要分析。72例患者（6.3%）在心脏移植住院期间死亡。平均存活出院天数为306（±87）天。在存活至出院的患者中，56%在心脏移植术后第一年至少再次入院一次。在调整临床和社会心理变量后，年龄较大、慢性肾病、2018年后分配变化以及首次住院时间较长与存活出院天数显著减少相关。
将存活出院天数等以患者为中心的指标纳入考量应继续作为我们移植领域的优先事项，因为它可能更好地反映与健康相关的生活质量。
