Impact of Late Referral on Cardiac Transplant Outcomes
Late referral for heart transplantation (HTx) is associated with worse patient outcomes. There are no universally accepted definitions of what constitutes a timely referral for HTx assessment. To evaluate the impact of late referral (LR) on HTx outcomes. This single-centre retrospective observationa...
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| Veröffentlicht in: | Heart, lung & circulation lung & circulation, 2022-11, Vol.31 (11), p.1524-1530 |
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| creator | Suo, Elizabeth Hopper, Ingrid Tee, Su Ling Patel, Hitesh C. Kaye, David M. |
| description | Late referral for heart transplantation (HTx) is associated with worse patient outcomes. There are no universally accepted definitions of what constitutes a timely referral for HTx assessment.
To evaluate the impact of late referral (LR) on HTx outcomes.
This single-centre retrospective observational study included 80 patients undergoing HTx between 2016–2019. We applied a simple clinical tool, derived from markers of advanced heart failure (HF), to classify LR in HTx patients and assess the impact of LR on HTx outcomes. Outcome measures included duration of intensive care unit (ICU) stay, total hospitalisation stay, cost of transplant admission and one-year mortality.
Based upon the clinical profile, LR was defined by the presence of four or more out of 10 criteria for more than 6 months in HTx patients. In this model, 34 patients were timely referrals and 46 were LR. Patients who were LR had: a longer median time between initial diagnosis and referral (3 vs 7 ys; p=0.03); more features of advanced HF, including inotrope requirements (p=0.004); more comorbidities (p=0.014); and hospitalisations (p |
| doi_str_mv | 10.1016/j.hlc.2022.06.693 |
| format | Article |
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To evaluate the impact of late referral (LR) on HTx outcomes.
This single-centre retrospective observational study included 80 patients undergoing HTx between 2016–2019. We applied a simple clinical tool, derived from markers of advanced heart failure (HF), to classify LR in HTx patients and assess the impact of LR on HTx outcomes. Outcome measures included duration of intensive care unit (ICU) stay, total hospitalisation stay, cost of transplant admission and one-year mortality.
Based upon the clinical profile, LR was defined by the presence of four or more out of 10 criteria for more than 6 months in HTx patients. In this model, 34 patients were timely referrals and 46 were LR. Patients who were LR had: a longer median time between initial diagnosis and referral (3 vs 7 ys; p=0.03); more features of advanced HF, including inotrope requirements (p=0.004); more comorbidities (p=0.014); and hospitalisations (p<0.0001). Late referral was not associated with longer ICU (p=0.14) or hospital stay (p=0.051), however LR incurred greater total in-hospital costs (p=0.011). There was no difference in one-year mortality (6% vs 9%; p=0.64).
Patients referred late for HTx are more unwell at time of referral and require greater in-hospital resource usage at the time of transplantation. Earlier referral for transplant assessment in patients with advanced HF should be encouraged.</description><identifier>ISSN: 1443-9506</identifier><identifier>EISSN: 1444-2892</identifier><identifier>DOI: 10.1016/j.hlc.2022.06.693</identifier><identifier>PMID: 35985947</identifier><language>eng</language><publisher>Australia: Elsevier B.V</publisher><subject>Heart failure ; Heart Failure - complications ; Heart Failure - surgery ; Heart Transplantation ; Humans ; Length of Stay ; Outcomes ; Referral ; Retrospective Studies ; Time Factors ; Treatment Outcome</subject><ispartof>Heart, lung & circulation, 2022-11, Vol.31 (11), p.1524-1530</ispartof><rights>2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)</rights><rights>Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c283t-d9e1e887f38576c773166202349a0c53a2ae841c27d635ca13f9e483216b3f0f3</citedby><cites>FETCH-LOGICAL-c283t-d9e1e887f38576c773166202349a0c53a2ae841c27d635ca13f9e483216b3f0f3</cites><orcidid>0000-0002-8805-370X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1443950622010083$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35985947$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suo, Elizabeth</creatorcontrib><creatorcontrib>Hopper, Ingrid</creatorcontrib><creatorcontrib>Tee, Su Ling</creatorcontrib><creatorcontrib>Patel, Hitesh C.</creatorcontrib><creatorcontrib>Kaye, David M.</creatorcontrib><title>Impact of Late Referral on Cardiac Transplant Outcomes</title><title>Heart, lung & circulation</title><addtitle>Heart Lung Circ</addtitle><description>Late referral for heart transplantation (HTx) is associated with worse patient outcomes. There are no universally accepted definitions of what constitutes a timely referral for HTx assessment.
To evaluate the impact of late referral (LR) on HTx outcomes.
This single-centre retrospective observational study included 80 patients undergoing HTx between 2016–2019. We applied a simple clinical tool, derived from markers of advanced heart failure (HF), to classify LR in HTx patients and assess the impact of LR on HTx outcomes. Outcome measures included duration of intensive care unit (ICU) stay, total hospitalisation stay, cost of transplant admission and one-year mortality.
Based upon the clinical profile, LR was defined by the presence of four or more out of 10 criteria for more than 6 months in HTx patients. In this model, 34 patients were timely referrals and 46 were LR. Patients who were LR had: a longer median time between initial diagnosis and referral (3 vs 7 ys; p=0.03); more features of advanced HF, including inotrope requirements (p=0.004); more comorbidities (p=0.014); and hospitalisations (p<0.0001). Late referral was not associated with longer ICU (p=0.14) or hospital stay (p=0.051), however LR incurred greater total in-hospital costs (p=0.011). There was no difference in one-year mortality (6% vs 9%; p=0.64).
Patients referred late for HTx are more unwell at time of referral and require greater in-hospital resource usage at the time of transplantation. Earlier referral for transplant assessment in patients with advanced HF should be encouraged.</description><subject>Heart failure</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - surgery</subject><subject>Heart Transplantation</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Outcomes</subject><subject>Referral</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1443-9506</issn><issn>1444-2892</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtLAzEUhYMotlZ_gBuZpZsZ85o8cCXFR6FQkLoOaeYGp8yjJjOC_97UVpdu7r2Lcw7nfghdE1wQTMTdtnhvXEExpQUWhdDsBE0J5zynStPTn5vlusRigi5i3GJMJGf6HE1YqVWpuZwisWh31g1Z77OlHSB7BQ8h2Cbru2xuQ1Vbl62D7eKusd2QrcbB9S3ES3TmbRPh6rhn6O3pcT1_yZer58X8YZk7qtiQVxoIKCU9U6UUTkpGhEh9GdcWu5JZakFx4qisBCudJcxr4IpRIjbMY89m6PaQuwv9xwhxMG0dHTSpDPRjNFRirkQaOknJQepCH2MAb3ahbm34MgSbPS6zNQmX2eMyWJiEK3lujvHjpoXqz_HLJwnuDwJIT37WEEx0NXQOqjqAG0zV1__EfwMTgHho</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Suo, Elizabeth</creator><creator>Hopper, Ingrid</creator><creator>Tee, Su Ling</creator><creator>Patel, Hitesh C.</creator><creator>Kaye, David M.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8805-370X</orcidid></search><sort><creationdate>202211</creationdate><title>Impact of Late Referral on Cardiac Transplant Outcomes</title><author>Suo, Elizabeth ; Hopper, Ingrid ; Tee, Su Ling ; Patel, Hitesh C. ; Kaye, David M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c283t-d9e1e887f38576c773166202349a0c53a2ae841c27d635ca13f9e483216b3f0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Heart failure</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - surgery</topic><topic>Heart Transplantation</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Outcomes</topic><topic>Referral</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suo, Elizabeth</creatorcontrib><creatorcontrib>Hopper, Ingrid</creatorcontrib><creatorcontrib>Tee, Su Ling</creatorcontrib><creatorcontrib>Patel, Hitesh C.</creatorcontrib><creatorcontrib>Kaye, David M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart, lung & circulation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suo, Elizabeth</au><au>Hopper, Ingrid</au><au>Tee, Su Ling</au><au>Patel, Hitesh C.</au><au>Kaye, David M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Late Referral on Cardiac Transplant Outcomes</atitle><jtitle>Heart, lung & circulation</jtitle><addtitle>Heart Lung Circ</addtitle><date>2022-11</date><risdate>2022</risdate><volume>31</volume><issue>11</issue><spage>1524</spage><epage>1530</epage><pages>1524-1530</pages><issn>1443-9506</issn><eissn>1444-2892</eissn><abstract>Late referral for heart transplantation (HTx) is associated with worse patient outcomes. There are no universally accepted definitions of what constitutes a timely referral for HTx assessment.
To evaluate the impact of late referral (LR) on HTx outcomes.
This single-centre retrospective observational study included 80 patients undergoing HTx between 2016–2019. We applied a simple clinical tool, derived from markers of advanced heart failure (HF), to classify LR in HTx patients and assess the impact of LR on HTx outcomes. Outcome measures included duration of intensive care unit (ICU) stay, total hospitalisation stay, cost of transplant admission and one-year mortality.
Based upon the clinical profile, LR was defined by the presence of four or more out of 10 criteria for more than 6 months in HTx patients. In this model, 34 patients were timely referrals and 46 were LR. Patients who were LR had: a longer median time between initial diagnosis and referral (3 vs 7 ys; p=0.03); more features of advanced HF, including inotrope requirements (p=0.004); more comorbidities (p=0.014); and hospitalisations (p<0.0001). Late referral was not associated with longer ICU (p=0.14) or hospital stay (p=0.051), however LR incurred greater total in-hospital costs (p=0.011). There was no difference in one-year mortality (6% vs 9%; p=0.64).
Patients referred late for HTx are more unwell at time of referral and require greater in-hospital resource usage at the time of transplantation. Earlier referral for transplant assessment in patients with advanced HF should be encouraged.</abstract><cop>Australia</cop><pub>Elsevier B.V</pub><pmid>35985947</pmid><doi>10.1016/j.hlc.2022.06.693</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-8805-370X</orcidid></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Heart failure Heart Failure - complications Heart Failure - surgery Heart Transplantation Humans Length of Stay Outcomes Referral Retrospective Studies Time Factors Treatment Outcome |
| title | Impact of Late Referral on Cardiac Transplant Outcomes |
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