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Internal and Emergency Medicine

, Volume 13, Issue 6, pp 907–913 | Cite as

Emergency department visits among patients with left ventricular assist devices

  • Christopher R. TainterEmail author
  • Oscar Ö. Braun
  • Felipe Teran
  • Albert P. Nguyen
  • Kimberly Robbins
  • Edward O. O’Brien
  • Zeb M. McMillan
  • Ulrich Schmidt
  • Angela Meier
  • Mat Goebel
  • Victor Pretorius
  • Michela Brambatti
  • Eric D. Adler
  • Raghu Seethala
EM - ORIGINAL

Abstract

Continuous-flow left ventricular assist devices (LVADs) are increasingly implanted to support patients with end-stage heart failure. These patients are at high risk for complications, many of which necessitate emergency care. While rehospitalization rates have been described, there is little data regarding emergency department (ED) visits. We hypothesize that ED visits are frequent and often require admission after LVAD implantation. We performed a retrospective review of patients in our health-care system followed by the advanced heart failure service for LVAD management after implantation between January 2011 and July 2015. We accounted for all ED visits in our system through February 2016, 7 months after the last implantation included. Clinically relevant demographic variables and ED visit details were recorded and analyzed to describe this population. We identified 81 patients with complete data, among whom there were 283 visits (3.49 visits/patient), occurring at a rate of approximately 7.3 ED visits per patient per year alive with LVAD. The most common reason for an ED visit is a complication related to bleeding (18% of visits), followed by chest pain (14%) and dizziness or syncope (13%). Thirty-six percent of patients were discharged from the ED without hospital admission. A growing populace with implanted LVADs represents an important population within emergency medicine. They are at risk for significant complications and frequently present to the ED. While many of these visits may be managed without hospital admission, this specialized patient group represents a potential area for improvement in provider education.

Keywords

LVAD Ventricular assist device CHF Emergency department Heart failure 

Notes

Acknowledgements

Statistical support was provided by James Proudfoot, MS, at the Clinical and Translational Research Institute at University of San Diego California. OÖB was supported by the Swedish Heart–Lung Foundation, the Crafoords Foundation, Märta Winklers Stiftelse, and Thorsten Westerströms Stiftelse. MB was supported by the College of Physician and Surgeons of Ancona, Italy.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board prior to data collection.

Statement of human and animal rights

The study was approved by the Institutional Review Board prior to data collection

Informed consent

For this type of study, formal consent was not required

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Copyright information

© SIMI 2017

Authors and Affiliations

  • Christopher R. Tainter
    • 1
    Email author
  • Oscar Ö. Braun
    • 2
  • Felipe Teran
    • 3
  • Albert P. Nguyen
    • 4
  • Kimberly Robbins
    • 4
  • Edward O. O’Brien
    • 4
  • Zeb M. McMillan
    • 4
  • Ulrich Schmidt
    • 4
  • Angela Meier
    • 4
  • Mat Goebel
    • 5
  • Victor Pretorius
    • 6
  • Michela Brambatti
    • 2
  • Eric D. Adler
    • 2
  • Raghu Seethala
    • 7
  1. 1.Department of Emergency Medicine and Division of Critical Care, Department of AnesthesiologyUC San DiegoSan DiegoUSA
  2. 2.Department of Medicine, Division of CardiologyUC San DiegoSan DiegoUSA
  3. 3.Department of Emergency MedicineThe Mount Sinai HospitalNew YorkUSA
  4. 4.Department of Anesthesiology, Division of Critical CareUC San DiegoSan DiegoUSA
  5. 5.UC San Diego School of MedicineSan DiegoUSA
  6. 6.Department of SurgeryUC San DiegoSan DiegoUSA
  7. 7.Department of Emergency MedicineBrigham and Women’s HospitalBostonUSA

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