Epistaxis Rates and Health Care Utilization in Patients With a Ventricular Assist Device

TL;DR

This study finds that nearly 30% of ventricular assist device patients seek medical care for nosebleeds, with GI bleeding and kidney disease increasing the risk.

Contribution

The study identifies epistaxis rates and healthcare utilization patterns in VAD patients and links GI bleeding and kidney disease to increased epistaxis risk.

Findings

29% of ventricular assist device (VAD) patients received medical attention for epistaxis.

GI bleeding and kidney disease are associated with increased odds of developing epistaxis.

Most epistaxis events occurred inpatient (59%) or in the emergency department (32.8%).

Abstract

Identify baseline epistaxis rates and epistaxis‐related health care utilization trends in the ventricular assist device (VAD) population.

Single center, retrospective cohort study consisting of chart review of adult VAD patients. Analysis of descriptive statistics was assessed using χ
2 tests, independent sample t tests, or Fisher's exact when expected counts were low. Logistic regression was used to assess associations between epistaxis and variables of interest.

Two hundred ninety patients were included in the analysis. Ninety‐eight (33.8%) patients developed epistaxis and 84 (29.0%) received medical attention. Patients with gastrointestinal (GI) bleeding had increased rates of epistaxis (42.4% vs 29.0%). Logistic regression analysis found GI bleeding to have an adjusted odds of developing epistaxis of 1.94 (95% confidence interval [CI]: 1.12‐3.37) and kidney disease to have an adjusted odds of 1.83 (95% CI: 1.06, 3.13).

VAD implantation improves survival and quality of life but also carries significant bleeding risks. At our institution, 29% of VAD patients received medical attention for epistaxis. GI bleeding and kidney disease were found to have increased adjusted odds of developing epistaxis. Fifty‐nine percent of epistaxis events occurred while inpatient and 32.8% of events were seen in the emergency department.

VAD patients are an at‐risk group that could potentially benefit from preventative nasal hydration regimen.

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