ED patients with ventricular assist devices (VADs) present some unique care challenges and also some legal risks. “ED providers are seeing an increasing number of these patients, and we expect that number will continue to increase,” says Jonathan B. Edelson, MD, an attending physician with the division of cardiology at Children’s Hospital of Philadelphia.
More patients are discharged from the hospital with VADs for two reasons: A limited supply of organs available for transplant, and improvements in mechanical circulatory support.
“The care model of patients with end-stage heart failure is changing,” Edelson notes. “However, there were very little data describing the interaction between these patients and the ED.”
It was unclear how often patients with VADs were visiting the ED, why they visited, or how the situation concluded. Edelson and colleagues analyzed 44,042 VAD-related ED visits, using the Nationwide Emergency Department Sample database.1 They found VAD-related ED visits increased sixteenfold from 2010-2017. Nearly three-quarters of these visits led to hospital admission.
One in 40 of the visits resulted in death (either in the ED or during hospital admission). More than half the visits were attributed to cardiac problems, bleeding, or infection. Almost one in 10 visits were because of stroke or a device complication.
To reduce risks for patients with VADs, Edelson says that providers can develop a familiarity with VADs (i.e., how they work, what complications need to be evaluated, and how to do so). Ensure systems are put in place for providers to care for these patients in an expeditious and effective way. Finally, remember that these are high-risk patients. “Understanding how to identify those patients at the highest risk of poor outcomes is critical,” Edelson says.
To help in this process, Edelson and colleagues developed and validated a risk score that assigns ED patients with VADs to one of three groups.2
“We hope this proves to be a useful tool for emergency department providers,” Edelson offers.
REFERENCES
- Edelson JB, Edwards JJ, Katcoff H, et al. An increasing burden of disease: Emergency department visits among patients with ventricular assist devices from 2010 to 2017. J Am Heart Assoc 2021;10:e018035.
- Edelson JB, Edwards JJ, Katcoff H, et al. 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. J Am Heart Assoc 2022;11:e020942.
To reduce risks for patients with ventricular assist devices, providers should learn how they work, what complications need to be evaluated, and how to do so. Ensure systems are put in place for providers to care for these patients in an expeditious and effective way.
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