Heart transplants declined sharply during pandemic

Date:
July 24, 2020
Source:
Columbia University Irving Medical Center
Summary:
Heart transplants, donor hearts, and transplant waitlists all fell
sharply at the start of the COVID-19 pandemic in the United States,
researchers have found.



FULL STORY ==========================================================================
The number of heart transplants in the United States declined sharply
during the beginning of the pandemic, even in areas of the country with
few COVID-19 cases at the time, according to an analysis by researchers
at Columbia University Irving Medical Center.


==========================================================================
The study found that the number of heart transplants performed nationwide dropped 26% during the 8-week period marking the height of the pandemic in
the Northeast compared to the prior 8 weeks. The drop in transplants was similar across regions and occurred even in areas with lower infection
rates.

The study was published in JAMA Cardiology.

"We had concerns that the availability of ICU beds and ventilators
would impact our transplant patients, particularly in the Northeast,"
says Ersilia DeFilippis, MD, a postdoctoral clinical fellow in medicine
and cardiology at Columbia University Vagelos College of Physicians and Surgeons and the first author of the paper.

"But we were surprised to see a decline in heart transplants in other
parts of the country, where there were far fewer COVID-19 cases at that
time. Our data show that this pandemic has had far-reaching impacts
on the care our patients with advanced heart failure are receiving."
Heart Transplant Patients Require Many Hospital Resources Heart transplant patients require a lot of hospital resources, DeFilippis says.

"Many patients are sick enough to require hospitalization prior to
transplant, often in an intensive care unit, sometimes for weeks or
months. Some of these patients are supported on temporary machines to
help their hearts pump blood to the body. In addition, the transplant
surgery itself requires a ventilator, blood products, and significant personnel. Patients then require intensive care unit monitoring in the immediate post-transplant period."


==========================================================================
At the beginning of the pandemic, clinicians had to weigh the risks of
exposing medically fragile patients with heart failure, though well
enough to remain at home, to SARS-CoV-2 infection with the risks of
delaying a life-changing surgery.

DeFilippis and her colleagues found that many clinicians reacted by
taking their patients off the waitlist -- a measure typically pursued
when a patient encounters a health issue that temporarily or permanently disqualifies them for transplantation but was expanded during the
pandemic to include patients at risk of SARS-CoV-2 infection and to
accommodate transplant centers that deferred acceptance of donor organs
due to the pandemic.

They found that waitlist inactivations increased 75% during the pandemic, driven largely by the Northeast. At the same time, 37% fewer people were
placed on heart transplant waitlists during the pandemic, with the most significant decreases occurring in the Northeast, the Great Lakes region,
and the Southwest.

In addition, the researchers found that the availability of donor
hearts decreased by 26% during the COVID-19 period compared with the pre-COVID-19 period.

"It is possible that limited access to testing for donors as well as restrictions on organ procurement organizations may have contributed to
the decrease we observed in donor recovery," says DeFilippis.



========================================================================== Next, the researchers plan to study the impact of these changes on patient survival while on the transplant waitlist and post-transplant survival.

"It will be similarly important to determine how the pandemic has affected
the timing of transplant evaluations and changes in left ventricular
assist device implantation. As the pandemic continues, we must be mindful
of the effects of these delays on our patients," says DeFilippis.

The paper, "Trends in US Heart Transplant Waitlist Activity and Volume
During the COVID-19 Pandemic," was published in JAMA Cardiology.

The other authors are Lauren Sinnenberg (Brigham and Women's Hospital
and Harvard Medical School, Boston, MA), Nosheen Reza (Perelman School
of Medicine at University of Pennsylvania, Philadelphia, PA), Michael
M. Givertz (Brigham and Women's Hospital and Harvard Medical School),
Michelle M. Kittleson (Cedars-Sinai Medical Center, Los Angeles, CA),
Veli K. Topkara (Columbia University Irving Medical Center, New York,
NY), and Maryjane A. Farr (CUIMC).


========================================================================== Story Source: Materials provided by
Columbia_University_Irving_Medical_Center. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. Ersilia M. DeFilippis, Lauren Sinnenberg, Nosheen Reza, Michael M.

Givertz, Michelle M. Kittleson, Veli K. Topkara, Maryjane
A. Farr. Trends in US Heart Transplant Waitlist Activity and Volume
During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA
Cardiology, 2020; DOI: 10.1001/jamacardio.2020.2696 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/07/200724120152.htm

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