An Analysis of Waitlist Inactivity Among Patients With Ventricular Assist Devices
Autor: | Robert S.D. Higgins, Chun W. Choi, Eric Etchill, Katherine Giuliano, James J. Whitbread, Ahmet Kilic, Alejandro Suarez-Pierre, Steven Hsu, Jennifer S. Lawton, Kavita Sharma |
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Rok vydání: | 2021 |
Předmět: |
Adult
Male medicine.medical_specialty Waiting Lists Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine parasitic diseases medicine Humans cardiovascular diseases Aged Bridge to transplant business.industry Incidence (epidemiology) Middle Aged medicine.disease Transplantation Organ procurement Increased risk 030220 oncology & carcinogenesis Heart failure Circulatory system Cardiology Female 030211 gastroenterology & hepatology Surgery Heart-Assist Devices biological phenomena cell phenomena and immunity business |
Zdroj: | Journal of Surgical Research. 260:383-390 |
ISSN: | 0022-4804 |
Popis: | Ventricular assist devices (VADs) are commonly used mechanical circulatory support for bridge to transplant therapy in end-stage heart failure; however, it is not understood how VADs influence incidence of waitlist inactive status. We sought to characterize and compare waitlist inactivity among patients with and without VADs.Using the Organ Procurement and Transplantation Network database, we investigated the VAD's impact on incidence and length of inactive periods for heart transplant candidates from 2005 through 2018. We compared median length of inactivity between patients with and without VADs and investigated inactivity risk with time-to-event regression models.Among 46,441 heart transplant candidates, 32% (n = 14,636) had a VAD. Thirty-eight percent (n = 17,873) of all patients experienced inactivity, of which 42% (7538/17,873) had a VAD. Median inactivity length was 31 d for patients without VADs and 62 d for VAD patients (P 0.0005). Multivariable analysis showed no significant difference in risk of inactivity for deteriorating conditions between patients with and without VADs after controlling for demographic and baseline clinical variables. A larger proportion of patients without VADs were inactive for deteriorating conditions than VAD patients (54%, n = 8242/15,221 versus 32%, n = 3583/11,086, P 0.001). Ten percent (1155/11,086) of VAD patients' inactive periods were for VAD-related complications.Although VAD patients were inactive longer and had an overall increased risk of any-cause inactivity, their risk of inactivity for deteriorating condition was not significantly different from patients without VADs. Furthermore, VAD patients had a smaller proportion of inactivity periods due to deteriorating conditions. Thus, VADs are protective from morbidity for waitlist patients. |
Databáze: | OpenAIRE |
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