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Days Alive and Out of the Hospital After Heart Transplantation: A Retrospective Cohort Study
Marcus R Bruce1, Peter E Frasco2, Kristen A Sell-Dottin3
1Department of Anesthesiology and Perioperative Medicine, Cardiothoracic Division, University of California San Diego, San Diego, CA.
Insights
Mechanical circulatory support (MCS) as a bridge to heart transplant did not significantly impact days alive and out of the hospital (DAOH) at 365 days. This outcome measure is crucial for understanding the post-transplant patient experience.
Area of Science:
- Cardiology
- Transplantation Medicine
- Outcomes Research
Background:
- Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
- Mechanical circulatory support (MCS) is increasingly used as a bridge to transplant.
- Evaluating post-transplant outcomes is essential for optimizing patient care.
Purpose of the Study:
- To assess if mechanical circulatory support (MCS) as a bridge to heart transplant affects the primary outcome of days alive and out of the hospital (DAOH) at 365 days post-transplant.
- To compare DAOH365 in patients with and without prior MCS.
- To identify predictors of reduced DAOH365.
Main Methods:
- Retrospective observational study of 235 adult heart transplant recipients between 2015 and 2020.
- Primary outcome: DAOH at 365 days (DAOH365).
- Poisson regression analysis was used to determine associations between variables and DAOH365.
Main Results:
- The median DAOH365 for the entire cohort was 348 days.
- No significant difference in DAOH365 was observed between patients with prior MCS (347 days) and those without MCS (348 days) (p=0.43).
- Multivariate analysis identified the 2018 heart transplant allocation change, pretransplant pulmonary hypertension, and increased total ischemic time as predictors of reduced DAOH365.
Conclusions:
- Prior use of MCS as a bridge to heart transplant did not significantly alter DAOH365.
- DAOH is a valuable metric for understanding the post-transplant patient experience.
- Incorporating DAOH into pre-transplant evaluations can enhance shared decision-making between patients and clinicians.
Objective:
Evaluate days alive and out of the hospital (DAOH) as an outcome measure after orthotopic heart transplantation in patients with mechanical circulatory support (MCS) as a bridge to transplant compared to those patients without prior MCS.
Design:
A retrospective observational study of adult patients who underwent cardiac transplantation between January 1, 2015, and January 1, 2020. The primary outcome was DAOH at 365 days (DAOH365) after an orthotopic heart transplant. A Poisson regression model was fitted to detect the association between independent variables and DAOH365.
Setting:
An academic tertiary referral center.
Participants:
A total of 235 heart transplant patients were included-103 MCS as a bridge to transplant patients, and 132 direct orthotopic heart transplants without prior MCS.
Measurements And Main Results:
The median DAOH365 for the entire cohort was 348 days (IQR 335.0-354.0). There was no difference in DAOH365 between the MCS patients and patients without MCS (347.0 days [IQR 336.0-353.0] v 348.0 days [IQR 334.0-354.0], p = 0.43). Multivariate analysis identified patients who underwent a transplant after the 2018 heart transplant allocation change, pretransplant pulmonary hypertension, and increased total ischemic time as predictors of reduced DAOH365.
Conclusions:
In this analysis of patients undergoing orthotopic heart transplantation, there was no significant difference in DAOH365 in patients with prior MCS as a bridge to transplant compared to those without MCS. Incorporating days alive and out of the hospital into the pre-transplant evaluation may improve understanding and conceptualization of the post-transplantation patient experience and aid in shared decision-making with clinicians.
