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Edelson JB, Edwards JJ, Katcoff H, Mondal A, Chen F, Reza N, Hanff TC, Griffis H, Mazurek JA, Wald J, Burstein DS, Atluri P, O'Connor MJ, Goldberg LR, Zamani P, Groeneveld PW, Rossano JW, Lin KY, Birati EY. Novel Risk Model to Predict Emergency Department Associated Mortality for Patients Supported With a Ventricular Assist Device: The Emergency Department-Ventricular Assist Device Risk Score. J Am Heart Assoc 2022; 11:e020942. [PMID: 35023355 PMCID: PMC9238533 DOI: 10.1161/jaha.121.020942] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The past decade has seen tremendous growth in patients with ambulatory ventricular assist devices. We sought to identify patients that present to the emergency department (ED) at the highest risk of death. Methods and Results This retrospective analysis of ED encounters from the Nationwide Emergency Department Sample includes 2010 to 2017. Using a random sampling of patient encounters, 80% were assigned to development and 20% to validation cohorts. A risk model was derived from independent predictors of mortality. Each patient encounter was assigned to 1 of 3 groups based on risk score. A total of 44 042 ED ventricular assist device patient encounters were included. The majority of patients were male (73.6%), <65 years old (60.1%), and 29% presented with bleeding, stroke, or device complication. Independent predictors of mortality during the ED visit or subsequent admission included age ≥65 years (odds ratio [OR], 1.8; 95% CI, 1.3-4.6), primary diagnoses (stroke [OR, 19.4; 95% CI, 13.1-28.8], device complication [OR, 10.1; 95% CI, 6.5-16.7], cardiac [OR, 4.0; 95% CI, 2.7-6.1], infection [OR, 5.8; 95% CI, 3.5-8.9]), and blood transfusion (OR, 2.6; 95% CI, 1.8-4.0), whereas history of hypertension was protective (OR, 0.69; 95% CI, 0.5-0.9). The risk score predicted mortality areas under the curve of 0.78 and 0.71 for development and validation. Encounters in the highest risk score strata had a 16-fold higher mortality compared with the lowest risk group (15.8% versus 1.0%). Conclusions We present a novel risk score and its validation for predicting mortality of patients with ED ventricular assist devices, a high-risk, and growing, population.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA.,Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Leonard Davis Institute for Healthcare EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Jonathan J Edwards
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Hannah Katcoff
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia Philadelphia PA
| | - Antara Mondal
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia Philadelphia PA
| | - Feiyan Chen
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia Philadelphia PA
| | - Nosheen Reza
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Thomas C Hanff
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Heather Griffis
- Leonard Davis Institute for Healthcare EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Jeremy A Mazurek
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Joyce Wald
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Danielle S Burstein
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Pavan Atluri
- Cardiothoracic Surgery Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Matthew J O'Connor
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Lee R Goldberg
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Payman Zamani
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Peter W Groeneveld
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,General Internal Medicine Division Department of Medicine Perelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Joseph W Rossano
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA.,Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA
| | - Kimberly Y Lin
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Edo Y Birati
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Cardiothoracic Surgery Perelman School of Medicine University of Pennsylvania Philadelphia PA.,The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery Padeh-Poriya Medical CenterBar Ilan University Israel
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Checchia PA, Brown KL, Wernovsky G, Penny DJ, Bronicki RA. The Evolution of Pediatric Cardiac Critical Care. Crit Care Med 2021; 49:545-557. [PMID: 33591011 DOI: 10.1097/ccm.0000000000004832] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Paul A Checchia
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Katherine L Brown
- Heart and Lung Division and Biomedical Research Centre, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Gil Wernovsky
- Cardiac Critical Care and Pediatric Cardiology, Children's National Medical Center and George Washington University School of Medicine and Health Sciences, Washington DC
| | - Daniel J Penny
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston TX
| | - Ronald A Bronicki
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Edelson JB, Edwards JJ, Katcoff H, Mondal A, Reza N, Hanff TC, Griffis H, Mazurek JA, Wald J, Owens AT, Burstein DS, Atluri P, O’Connor MJ, Goldberg LR, Zamani P, Groeneveld PW, Rossano JW, Lin KY, Birati EY. An Increasing Burden of Disease: Emergency Department Visits Among Patients With Ventricular Assist Devices From 2010 to 2017. J Am Heart Assoc 2021; 10:e018035. [PMID: 33543642 PMCID: PMC7955344 DOI: 10.1161/jaha.120.018035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/10/2020] [Indexed: 12/14/2022]
Abstract
Background With a growing population of patients supported by ventricular assist devices (VADs) and the improvement in survival of this patient population, understanding the healthcare system burden is critical to improving outcomes. Thus, we sought to examine national estimates of VAD-related emergency department (ED) visits and characterize their demographic, clinical, and outcomes profile. Additionally, we tested the hypotheses that resource use increased and mortality improved over time. Methods and Results This retrospective database analysis uses encounter-level data from the 2010 to 2017 Nationwide Emergency Department Sample. The primary outcome was mortality. From 2010 to 2017, >880 million ED visits were evaluated, with 44 042 VAD-related ED visits identified. The annual mean visits were 5505 (SD 4258), but increased 16-fold from 2010 to 2017 (824 versus 13 155). VAD-related ED visits frequently resulted in admission (72%) and/or death (3.0%). Median inflation-adjusted charges were $25 679 (interquartile range, $7450, $63 119) per encounter. The most common primary diagnoses were cardiac (22%), and almost 30% of encounters were because of bleeding, stroke, or device complications. From 2010 to 2017, admission and mortality decreased from 82% to 71% and 3.4% to 2.4%, respectively (P for trends <0.001, both). Conclusions We present the first study using national-level data to characterize the growing ED resource use and financial burden of patients supported by VAD. During the past decade, admission and mortality rates decreased but remain substantial; in 2017 ≈1 in every 40 VAD ED encounters resulted in death, making it critical that clinical decision-making be optimized for patients with VAD to maximize good outcomes.
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Affiliation(s)
- Jonathan B. Edelson
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPA
| | - Jonathan J. Edwards
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Hannah Katcoff
- Department of Biomedical Health Informatics, Healthcare Analytics Unitthe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Antara Mondal
- Department of Biomedical Health Informatics, Healthcare Analytics Unitthe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Nosheen Reza
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Thomas C. Hanff
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Heather Griffis
- Department of Biomedical Health Informatics, Healthcare Analytics Unitthe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Jeremy A. Mazurek
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Joyce Wald
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Anjali T. Owens
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Danielle S. Burstein
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Pavan Atluri
- Department of Biomedical Health Informatics, Healthcare Analytics Unitthe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Matthew J. O’Connor
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Lee R. Goldberg
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Payman Zamani
- Cardiothoracic SurgeryPerelman School of MedicinePhiladelphiaPA
| | - Peter W. Groeneveld
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPA
- General Internal Medicine DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
| | - Joseph W. Rossano
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
| | - Kimberly Y. Lin
- Division of CardiologyCardiac Centerthe Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Edo Y. Birati
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of PennsylvaniaPhiladelphiaPA
- Cardiovascular DivisionDepartment of MedicinePerelman School of MedicinePhiladelphiaPA
- Cardiovascular DivisionPoriya Medical CenterBar Ilan UniversityRamat GanIsrael
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