Geographic Variation in the Treatment of Adult Heart Transplant Candidates in the US
1University of Chicago, Chicago, IL
2Northwestern University, Chicago, IL.
Meeting: 2018 American Transplant Congress
Abstract number: B30
Keywords: Allocation, Heart, Public policy
Session Information
Session Name: Poster Session B: Heart and VADs: All Topics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
The current priority ranking system for US heart transplant candidates is based on treatment intensity which may encourage the overtreatment of relatively stable candidates. We aimed to describe national variation in the intensity of treatment of adult heart transplant candidates and identify center-level predictors of potential overtreatment.
Methods: SRTR data on all adult heart transplant candidates listed from 2010-2015 was collected. Candidates at-risk for overtreatment were defined as those who were not in cardiogenic shock by American Heart Association criteria. Non-shock candidates treated with high-dose inotropes or intra-aortic balloon pumps were defined as “potentially overtreated.” Multilevel logistic regression was used to “risk-standardize” center rates for candidate mix. Center-level variables associated with potential overtreatment were identified using multilevel models.
Results: From 2010-2015, one-hundred eight transplant centers listed 12,762 adult heart candidates who were not in cardiogenic shock and 1,471 (11.6%) were potentially overtreated with high-dose inotropes or intra-aortic balloon pumps (Fig 1). In the bottom quartile of centers only 2.1% candidates were potentially overtreated compared to 27.6% of candidates listed in the top quartile, an inter-quartile difference of 25.5% (95% CI 21%-30%). Adjusting for differences in candidates did not significantly alter the distribution of center rates (Fig 2). Local competition with two or more centers increased the odds of overtreatment by 50% (aOR 1.50, 95% CI 1.07-2.11).
Conclusion: There is substantial variation in the treatment practices of US adult heart transplant centers. Competition for transplantable hearts is associated with potential overtreatment of heart transplant candidates.
CITATION INFORMATION: Parker W., Churperk M., Hedeker D., Huang E., Garrity E., Siegler M., Anderson A. Geographic Variation in the Treatment of Adult Heart Transplant Candidates in the US Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Parker W, Churperk M, Hedeker D, Huang E, Garrity E, Siegler M, Anderson A. Geographic Variation in the Treatment of Adult Heart Transplant Candidates in the US [abstract]. https://atcmeetingabstracts.com/abstract/geographic-variation-in-the-treatment-of-adult-heart-transplant-candidates-in-the-us/. Accessed May 13, 2025.« Back to 2018 American Transplant Congress