Retrospective evaluation of emergency department admissions in patients with ventricular assist device

Background: Ventricular assist devices, improve morbidity and survival in patients with end-stage heart failure. Objectives: To evaluate the major causes of emergency department admissions in patients with ventricular assist device support. Methods: The charts of 200,000 adult patients who presented to our emergency department between January 2016 and January 2018 were reviewed retrospectively. A total of 444 emergency department visits made by 99 patients with ventricular assist device were included in the study. Results: The annual incidence of emergency department admissions of patients with ventricular assist device was 0.1%. The mean age was 55.5 +- 11.1 years and 85.9% of the study population were men. The most commonly encountered diagnoses were abnormal international normalized ratio or international normalized ratio follow-up (18.2%); heart failure, non-specific chest pain, and chronic obstructive pulmonary disease (15.3%); minor/major bleeding (12.1%); neurological disorders such as ischemic stroke, transient ischemic attack, vertigo, migraine, and syncope (11.2%); non-device related infections (10.8%); ventricular tachycardia/fibrillation episode (8.5%); musculoskeletal disorders (7.2%); and devicerelated complications such as driveline infection and pump thrombosis (6.3%). Of the patients with bleeding, 31.1% had intracranial bleeding, 31.1% had epistaxis, 24% had gastrointestinal bleeding, 11.1% had hematuria, and 1.8% had gingival hemorrhage. Of the 15 patients who died, 73.3% were diagnosed with intracranial hemorrhage. Conclusion: Even though the mortality rates of patients with ventricular assist device tends to decrease, these patients still have significant morbidity due to the increase in the prevalence of ventricular assist device use. Except for devicerelated problems, emergency department management of this patient group does not differ much from other patient groups. As early diagnosis of any device-related problems is mandatory for decreasing mortality, emergency department physicians should be familiar with mechanical support systems.