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. 2022 Jan 18;11(2):e020942.
doi: 10.1161/JAHA.121.020942. Epub 2022 Jan 13.

Novel Risk Model to Predict Emergency Department Associated Mortality for Patients Supported With a Ventricular Assist Device: The Emergency Department-Ventricular Assist Device Risk Score

Jonathan B Edelson  1   2   3 , Jonathan J Edwards  1 , Hannah Katcoff  4 , Antara Mondal  4 , Feiyan Chen  4 , Nosheen Reza  5 , Thomas C Hanff  5 , Heather Griffis  3 , Jeremy A Mazurek  5 , Joyce Wald  5 , Danielle S Burstein  1 , Pavan Atluri  6 , Matthew J O'Connor  1 , Lee R Goldberg  2   5 , Payman Zamani  5 , Peter W Groeneveld  2   7 , Joseph W Rossano  1   2 , Kimberly Y Lin  1 , Edo Y Birati  2   6   8
Affiliations

Novel Risk Model to Predict Emergency Department Associated Mortality for Patients Supported With a Ventricular Assist Device: The Emergency Department-Ventricular Assist Device Risk Score

Jonathan B Edelson et al. J Am Heart Assoc. .

Abstract

Background The past decade has seen tremendous growth in patients with ambulatory ventricular assist devices. We sought to identify patients that present to the emergency department (ED) at the highest risk of death. Methods and Results This retrospective analysis of ED encounters from the Nationwide Emergency Department Sample includes 2010 to 2017. Using a random sampling of patient encounters, 80% were assigned to development and 20% to validation cohorts. A risk model was derived from independent predictors of mortality. Each patient encounter was assigned to 1 of 3 groups based on risk score. A total of 44 042 ED ventricular assist device patient encounters were included. The majority of patients were male (73.6%), <65 years old (60.1%), and 29% presented with bleeding, stroke, or device complication. Independent predictors of mortality during the ED visit or subsequent admission included age ≥65 years (odds ratio [OR], 1.8; 95% CI, 1.3-4.6), primary diagnoses (stroke [OR, 19.4; 95% CI, 13.1-28.8], device complication [OR, 10.1; 95% CI, 6.5-16.7], cardiac [OR, 4.0; 95% CI, 2.7-6.1], infection [OR, 5.8; 95% CI, 3.5-8.9]), and blood transfusion (OR, 2.6; 95% CI, 1.8-4.0), whereas history of hypertension was protective (OR, 0.69; 95% CI, 0.5-0.9). The risk score predicted mortality areas under the curve of 0.78 and 0.71 for development and validation. Encounters in the highest risk score strata had a 16-fold higher mortality compared with the lowest risk group (15.8% versus 1.0%). Conclusions We present a novel risk score and its validation for predicting mortality of patients with ED ventricular assist devices, a high-risk, and growing, population.

Keywords: mortality; risk score; ventricular assist device.

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Figures

Figure 1
Figure 1. Risk score frequency in the development cohort.
Figure 2
Figure 2. Observed mortality in the development cohort.
An increasing risk score correlated with an increased rate of observed mortality.
Figure 3
Figure 3. Observed mortality by risk group.
Figure 4
Figure 4. Receiver operator characteristic curves for development (A) and validation cohorts (B).
The risk score model had a good discrimination on receiver operating characteristics with an area under the curve in development and validation cohorts of 0.78 and 0.71. ROC indicates receiver operator characteristic.
Figure 5
Figure 5. Relationship between risk score to resource use.
An increased risk score also correlated with increased resource use.
See this image and copyright information in PMC

Comment in

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