Morbidity and mortality of UNOS status 1B cardiac transplant candidates at home.
BACKGROUND
On January 20, 1999, UNOS listing regulations changed, allowing stable patients on inotropic support (Status IB) to be discharged home until cardiac transplant. The outcome, morbidity and cost savings of this new strategy has not been evaluated.


METHODS
From 1/20/99 through 1/1/01, 155 patients were classified as UNOS Status 1B at our institution; 64 patients were never discharged and 91 were discharged home. Criteria for discharge were hemodynamic stability on low-dose, single-agent parenteral inotropic infusion, defined as dobutamine at a dose <7.5 microg/kg/min or milrinone <0.5 microg/kg/min. Data on re-admissions were collected prospectively. The frequency of complex ventricular arrhythmias was evaluated in a sub-group discharged with external or internal cardiodefibrillators (n = 38).


RESULTS
Total Status I time to transplant for the 91 discharged patients was 139 +/- 91 days, with 87 +/- 67 days spent at home. Inpatient time to transplant was still high, with a mean of 51 +/- 45 days. The in-hospital time was comparable to that of the 64 patients who were never discharged (51 +/- 41 days). Fifty-nine percent of discharged patients were re-admitted, with 37% of patients requiring more than 1 admission. Sixty-six percent of admissions were for worsening heart failure (CHF), and 34% for infection or occlusion of the indwelling intravenous line. No significant arrhythmic events were recorded in the 38 patients who had internal or external cardiodefibrillators. Two patients died suddenly at home. One patient had declined to wear the external cardiodefibrillator. The other patient was not wearing the defibrillator at the time of the event, and in 634 hours of previous monitoring he had had no events.


CONCLUSIONS
In UNOS Status 1B patients awaiting cardiac transplant on home inotropic therapy, mortality remains low but the re-admission rate was high. There appeared to be a low incidence of complex ventricular arrhythmias.
Lang
Chim C
CC
Department of Medicine, Columbia Presbyterian Medical Center, New York, New York 10032, USA.
Hankins
Shelley
S
Hauff
Helen
H
Maybaum
Simon
S
Edwards
Niloo
N
Mancini
Donna M
DM
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004280:Dobutamine / Q000191:economics / Q000627:therapeutic use; D004554:Electric Countershock / Q000191:economics; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D016027:Heart Transplantation / Q000191:economics*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000191:economics / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014850:Waiting Lists
D002316:Cardiotonic Agents; D004280:Dobutamine; D020105:Milrinone