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Prediction of wait times in heart transplantation in Portugal
Session:
Sessão de Posters 40 - Insuficiência cardíaca - da Preservada ao Transplante
Speaker:
Carlos Aguiar
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Carlos Aguiar; Fátima Franco; Sandra Amorim; António Valentim Gonçalves; Rita Ilhão Moreira; Marta Marques; David Prieto; Paulo Pinho; Pedro Coelho; António Martinho; Margarida Ivo
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Introduction: Wait times for heart transplantation vary significantly among patients. Prolonged wait times are well established as a risk factor for poor post-transplant outcomes. Durable left ventricular assist devices substantially improve waitlist survival and may be used as a bridge-to-transplant in eligible candidates. We aimed to identify predictors of wait time for heart transplantation in Portugal. </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Methods: We reviewed data for 229 patients who underwent heart transplantation between January 1, 2018, and December 15, 2023, in any of the 4 heart transplantation centers in Portugal. We performed univariate and multivariate analyses of the waiting times. Variables considered included age at listing, sex, blood type, weight and body mass index at listing, urgency status at listing, and pulmonary hypertension. We used a Cox proportional hazards model to evaluate the simultaneous effect of multiple variables on the waiting time of heart transplant candidates. </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Results: Most heart transplant recipients were male (71%), over 50 years old (median age 54 years) at the time of listing for transplantation, and blood type A (56%). The medical urgency status on the day the patient was listed for transplantation was grade 1 to 4 (emergent) in 31% patients, grade 5 or 6 (urgent) in 61%, and grade 7 (elective) in 8% (data available for 152 patients). Only 30% were transplanted within 3 months of being listed, whereas 10% were transplanted after 1 year on the waiting list. The median wait time for the overall cohort was 93 days (interquartile range: 26 days, 190 days). In univariate analyses, wait time was significantly associated with blood type (median wait time was 167 days for blood type B, 121 days for type O, 84 days for type A, and 33 days for type AB) and with urgency status on initial listing (median wait time was 21 days for emergent listings, days for 128 urgent listings, and 225 days for elective listings). In multivariate analyses, both variables were significantly and independently associated with wait time (p < 0.001): wait time was 2-fold higher among patients with a non-A blood type compared with blood type A patients (odds ratio 2.16; 95% CI, 1.53-3.06); wait time was 7-fold higher among patients with an urgent status on initial listing compared with patients with and emergent status (odds ratio 7.40; 95% CI, 3.68-14.86). </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusions: This study is the first nationwide analysis of wait times in heart transplantation in Portugal. The results have the potential to describe the wait-time duration more accurately for an individual patient, which may influence care decisions. </span></span></p>
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