Hospitalisation and life support in the year before and during heart transplantation: a French national study

Abstract

ObjectiveThe objective of this study was to define the characteristics of hospital care use during the year prior to heart transplantation.MethodsA retrospective cohort of heart transplant recipients registered on the national hospital discharge database between 2010 and 2015 was analysed.ResultsIn this cohort of 2379 heart transplant recipients (mean age: 48 years, 74% men), 91% had been admitted at least once, for at least 1 day, to a short-stay hospital during the year before transplantation (mean: 4.3 days), and 84% had at least one cardiovascular diagnosis (heart failure and cardiogenic shock: 60%). At least one intensive care stay was reported for 61% of patients, a rehabilitation stay was reported for 30%, mechanical circulatory support was reported for 12%, and ventilatory support was reported for 15%. The median interval between admission and transplantation was 5 days (interquartile QI–Q3, 0–16). The hospital mortality was higher for patients not hospitalised before transplantation (18% vs 15%). Their transplantation hospitalisation diagnosis, compared with patients hospitalised before transplantation, was more frequently cardiomyopathy (31% vs 27%) or heart failure (28% vs 18%), and less frequently myocardial infarction (1% vs 12%).ConclusionThis study demonstrates a high hospitalisation rate before heart transplantation and identifies three groups of patients: 1—patients with a high hospitalisation rate and terminal heart failure requiring circulatory support who experienced at least one intensive care unit stay; 2—patients with a history of hospitalisation, mainly for heart disease, without circulatory support requirement; and 3—patients with no pretransplantation overnight stay. These findings provide useful information to evaluate the medical benefits and needs for transplantation, and identify areas for improvement in heart transplantation listing criteria.