PEDS5: VAD Discharge at Pediatric Centers- Why can’t we get home?
Bibliographic record
Abstract
Background: The use of intra-corporeal continuous flow ventricular assist devices (CF-VAD) has allowed patients with advanced heart failure to be discharged home. Moreover, it has been shown that heart transplant (HTx)>30 days after VAD implant offers some survival benefit. Despite this, only about 50% of patients at pediatric centers are discharged, while others remain in hospital until HTx. We sought to characterize the cohort of patients who are transplanted during their index VAD admission as a means to identify potential barriers to discharge. Methods: Using the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry, individuals who underwent implant with a dischargeable VAD (HVAD and HM3) at a pediatric center were included. Data including patient demographics, characteristics and clinical course were compared between the discharged versus hospitalized cohorts. Patients who recovered or died during their VAD admission were excluded. Results: From December 2012 to June 2022, 220 patients underwent implant with HM3 (n=108) or HVAD (n=111) across 32 pediatric centers. Overall, 28% (62/220) of patients remained hospitalized until HTx. There was no significant difference in age, underlying diagnosis, days to extubation, INTERMACS profile, or history of ECMO in those who were discharged versus hospitalized. There was also no significant difference in adverse events including stroke, bleeding, infection, hepatic or renal dysfunction, or right heart failure between the two groups (See Table 1). Patients with HM3 were less likely to be discharged if lower BSA (p=0.05) or on BiVAD support (p=0.04). Conclusion: Although discharge in VAD patients at pediatric centers is improving, nearly one-third of patients undergoing implant with dischargeable VADs remain hospitalized until transplant. There was no significant difference in markers of severity of illness or adverse events in those who remain hospitalized versus discharged. Thus, perceived non-medical barriers by providers or families may be limiting discharge at pediatric centers and may be a potential target for further education.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.013 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".