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Continuously Updated Estimation of Heart Transplant Waitlist Mortality
Eugene H Blackstone1, Jeevanantham Rajeswaran2, Vincent B Cruz3
1Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
Journal of the American College of Cardiology
|August 4, 2018
Summary
Developing a dynamic tool to continuously update heart transplant waitlist mortality risk is crucial. This approach, incorporating adverse events and organ function, can inform clinical decisions and potentially reduce deaths while awaiting transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Decision Making
Background:
- Current US heart transplant allocation relies on infrequent, coarse tiers.
- Many patients awaiting heart transplantation die due to deteriorating conditions.
- A continuous risk assessment tool is needed to inform clinical decisions.
Purpose of the Study:
- To develop a decision aid for continuously updated waitlist mortality estimates.
- To aggregate adverse events and end-organ function measures.
- To inform clinical decision-making for heart transplant candidates.
Main Methods:
- Analysis of 414 heart transplant candidates listed from 2008-2013.
- Endpoint: waitlist death.
- Continuous re-computation of mortality risk at each event or measurement change.
Main Results:
- 77 waitlist deaths occurred; 1-year survival was 85%, 4-year was 57%.
- Time-varying events and measurements superseded pre-listing characteristics in mortality models.
- Neurological events, new dialysis requirement, respiratory complications, and elevated bilirubin/creatinine significantly predicted mortality.
Conclusions:
- Waitlist mortality is linked to dynamic adverse events and end-organ dysfunction.
- Continuously updated mortality estimates can guide clinical evaluations and status changes.
- This approach may reduce mortality among patients awaiting heart transplantation.
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