While a vast majority of heart transplants (HT) in the United States are successful, unplanned hospitalizations are still incredibly common. In fact, one 2018 analysis found that 62% of heart transplant patients are hospitalized within 60 days of the procedure.
What leads to these unplanned hospitalizations? A team of specialists aimed to find out, sharing its findings in Current Problems in Cardiology.[1]
“There is limited data regarding causes of rehospitalization post one year after transplant,” wrote first author Husam M. Salah, MD, a specialist with the department of medicine at the University of Arkansas for Medical Sciences, and colleagues. “With the improvement in HT outcomes and the growing population of HT recipients with a median survival of 12 years, it becomes imperative to identify the leading causes of hospitalizations among this population.”
Salah et al. examined data from the National Inpatient Sample, focusing on heart transplants performed from 2004 to 2018. Only adult patients were included in the analysis.
The number of hospitalizations increased from 11,244 in 2004 to 16,035 in 2018. The adjusted all-cause inpatient mortality decreased from 2.99% in 2004 to 1.01% in 2018.
In addition, the adjust length of stay decreased from 6.11 days in 2004 to 5.62 days in 2018, but hospitalization costs “did not change significantly.”
“Despite an increase in comorbidity burden over time, it is reassuring that all-cause inpatient mortality and adjusted LOS for hospitalizations of HT recipients have decreased over the study period, which may be attributed to improved clinician awareness and care for transplant recipients,” the authors wrote.
Due to the shift from ICD-9 codes to ICD-10 codes in 2015, the authors separated their data into two groups: heart transplant recipients hospitalized from 2004 to 2014 and those who were hospitalized from 2016 to 2018.
The 10 most common reasons for hospitalization among heart transplant patients from 2004 to 2014:
- Pneumonia
- Acute and unspecified renal failure
- Device complications
- Septicemia
- Congestive heart failure
- Complications related to the procedure or medical care
- Intestinal infection
- Fluid and electrolyte disorders
- Skin and subcutaneous tissue infections
- Rehabilitation care (device adjustments, etc.)
The 10 most common reasons for hospitalization among heart transplant patients from 2016 to 2018:
- Septicemia
- Acute and unspecified renal failure
- Device complications
- Pneumonia
- Complications related to the procedure or medical care
- Congestive heart failure
- Intestinal infection
- Rehabilitation care (device adjustments, etc.)
- Skin and subcutaneous tissue infections
- Fluid and electrolyte disorders
One of the team’s biggest takeaways from this analysis was that inpatient mortality is decreasing as time goes on. The inpatient mortality rate associated with congestive heart failure from 2004 to 2014, for example, was 3.63%. From 2016 to 2018, however, the inpatient mortality rate associated with the same complication was 2.5%.
In addition, the researchers found that infections, acute renal failure and device complications (complications with the transplanted heart) were the “three leading causes of hospitalization” when reviewing the results from both time periods.
The potential impact of COVID-19
Salah et al. wrote that it remains unclear how the COVID-19 pandemic, which began just a few years after the window of time included in this study, will impact these trends going forward.
“In a case series study, COVID-19 infection was associated with a mortality rate of 25% among heart transplant recipients,” they wrote. “Additional studies are needed to identify the extent of COVID-19 pandemic on hospitalization of heart transplant recipients.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.