Editor’s Note: Find the latest Medscape COVID-19 news and guidance Coronavirus Resource Center..
From mid-March to mid-May, both heart donor recovery and heart transplant volume fell 26% nationwide compared to the beginning of 2020.
The greatest impact of COVID-19 on heart transplant activity was seen in the nation’s most devastating northeast, but transplant activity was also significantly reduced in other areas, including areas with few viral cases. ..
All regions of the United States had reduced donor recovery compared to pre-COVID, with no reduction in heart transplantation in the northwestern region alone.
At the same time, 600 patients in need of a new heart were removed from the waiting list. This shows a 75% increase in deactivation compared to earlier this year. Of the 600, 403 (67%) were reported to be due to COVID-19 precautions.
Not surprisingly, COVID-19 was the most inactivated in the northeast (196), followed by the southwest (81) and the Great Lakes (63). For context, United network for organ sharing (UNOS) Currently, 3131 adults are waiting for a heart transplant in the United States.
“The number of patients removed from the waiting list of COVID considerations in New York didn’t surprise me, given the changes that I have to make here to manage COVID-19, but in most of the countries The fact that these reductions were observed was due to the complex interactions between wider organ sharing and the new allocation system, not only in transplantation but also in donor recovery, which led to changes in specific practices in specific areas. I think it has a huge impact on patients awaiting organs nationwide,” said Dr. El Silia de Philippis, New York Presbyterian Hospital/Columbia University Irving Medical Center in New York City.
Under study Just published To JAMA cardiovascular system, DeFilippis and colleagues Heart transplantBlends transplant data from UNOS with regional figures for the COVID-19 case load from the Centers for Disease Control and Prevention.
From March 15, UNOS has allowed transplant specialists to show whether patient inactivation is due to COVID-19 precautions. On this basis, DeFilippis and colleagues considered January 19-March 15 as the pre-COVID period and March 15-May 9 as the COVID period.
DeFilippis has allowed COVID-19 to have been prevalent in some communities prior to this date. So some “pre-COVID” deactivations may also be due to COVID-19, but they are not registered as such.
These data are not surprising to Dr. Nader Moazami, MD, NYU’s NYU Langone Health surgical director of heart transplant and mechanical circulatory support. His program inactivated the patient, discontinued the transplant at the end of March, and did not resume normal activity until late May.
“This is a very dynamic situation, how to test donors for ICU beds, ventilators, PPE, COVIDs, the risk that COVIDs transplant recipients and staff, if immunosuppressed patients get COVIDs.” Remedy-19 — It’s like a perfect storm, and I think there was enough consensus here in the New York area that a heart transplant should be stopped unless absolutely necessary.” theheart.org | Medscape Cardiology.
In the NYU, they made three to four transplants a month, moving to no transplants, but thankfully, patients did not die. Two patients had an implanted ventricular assist device to fill them over this period, he shared.
“We had meetings every day and the patient was very carefully monitored using a telehealth system, so if the patient could die while waiting, act before anything goes wrong, We considered other options for that patient,” Moazami said. “And in the meantime, no one patient died.”
DeFilippis believes that her hospital did only a few heart transplants during this period. The heart transplant was already waiting in-house for the heart and couldn’t get home due to illness.
“These were highly ill patients who were waiting in the hospital a few weeks to months ago, and the risk of not having a transplant was higher than the risk of having a transplant,” she said.
risk avoidance
The decline in transplant activity does not surprise health economist Dr. Sarah Machado (London School of Economics) who studies organ donation and transplant.
“Organizational procurement has traditionally been conservative and risk averse-learned from past mistakes-so in this situation where the environment was very difficult to control, stop until it is safe to continue Is natural,” she said. theheart.org | Medscape Cardiology.
The new allocation system allows organ-sourcing organizations to cross the borders of the region to seize the recovery of the most ill patients, but during the pandemic, their recovery is “very problematic”. She said In addition, COVID-19’s donor testing difficulties, hospital access and travel restrictions, and many donor sites simply opted out.
“UNOS responded very quickly to the situation because it has very few decision nodes and is a very centralized system with good regional cooperation.”
Clinicians were not the only ones who wanted to avoid the risks of this period. DeFilippis also reported that the number of patients added to the waiting list was reduced by 38% compared to the time before COVID was applied, and that patients are also making some decisions about care. is showing.
“What we noticed was that we didn’t just stop the transplant activity, especially in New York, where COVIDs were so high that patients were afraid to be hospitalized. At some point. , The whole hospital was full of COVID patients, this was our last place heart failure Patients wanted to be, and few came for a new assessment of transplant.”
He suspects that some of the excess deaths recorded in New York during that time may have been patients who opted out for transplant evaluation.
“What is interesting to me is that in that phase I didn’t even see the kind of patients that I used to see. Those who were hospitalized with really bad heart failure and needed treatment. Where do these patients go? I’m not sure, but looking at data suggesting that the mortality rate in New York State was double that of the previous year, counting COVID mortality wonders if some of these patients died. There is a need.”
by A few, Heart transplant activity has now solidly recovered in the northeastern region, but is slightly depressed in the southeastern part.
DeFilippis, Moazami, and Machado do not disclose related financial relationships.
Cardior JAMA. Published July 22, 2020 Online. Full text
More about theheart.org | Join Medscape Cardiology twitter And Facebook..
