Abstract 12805: Risk Factors of Mortality in Patients on Temporary Mechanical Circulatory Support Undergoing Heart Transplant

Introduction: Recent studies have shown a rise in temporary mechanical circulatory support (MCS) use among patients requiring heart transplants(HT) in the United States. However, there is a lack of data on the potential risk factors for death among HT patients who also used MCS. We, therefore, explored the National Inpatient Sample(NIS) database to investigate further.

Methods: All procedures for HT in adults via the 2016-2020 NIS were retained for our study. The use of MCS was also identified via procedural codes based on previous studies. We estimated factors that could influence mortality among MCS patients via multivariable regression analysis.

Results: Our selection criteria yielded 14545 cases of HT between 2016-2020, and an estimated 31.6%(4590) patients used MCS. A higher mortality rate in MCS patients was reported as 10.1% (465 cases out of 4590) did not survive (vs. 3.1% in non-MCS patients, aOR 3.473, 95% CI 2.966-4.066, p<0.01). In the MCS cohort, patients who died were older (mean age 56.13 vs. 53.65 years), with a higher mean Charlson Comorbidity Index (CCI) score ( mean score of 6.03 vs. 4.30, p<0.01). Factors that contributed to an increased odds of death included Weekend admissions (aOR 1.413, 95% CI 1.086-1.839, p=0.10), Hispanics (vs. Whites, aOR 1.926, 95% CI 1.398-2.652, p<0.01), history of peripheral vascular disease (PVD) (aOR 4.426, 95% CI 2.712-7.221, p<0.01), obesity (aOR 1.668, 95% CI 1.238-2.248, p<0.01), age ≥60years (aOR 1.982, 95% CI 1.593-2.466, p<0.01), and patients covered by private insurance forms (vs. Medicare, aOR 1.341, 95% CI 1.067-1.685, p=0.012). Meanwhile, those with lipid disorders (aOR 0.313, 95% CI 0.234-0.418, p<0.01) and a history of stroke (aOR 0.484, 95% CI 0.246-0.954, p=0.036) showed lower mortality risks.

Conclusions: Patients who used MCS and are now undergoing HT are at a higher risk of death. Weekend admissions, Hispanics, PVD, obesity, age ≥60 years, and private insurance were linked with higher risks in the MCS cohort, while a history of stroke and lipid disorders had lower risks. Thus, physicians must address these risk factors in their choice of care and provide the appropriate steps to reduce mortality.