Abstract 14418: Association Between 2018 Unos Heart Transplant Policy Changes and Likelihood of Transplant for Patients in Rural versus Urban Settings

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Khadijah Breathett ◽  
Shannon Knapp ◽  
Daniel Addison ◽  
Nishaki Mehta ◽  
Nancy Sweitzer ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Policy Change ◽  
Heart Transplant ◽  
Geographic Location ◽  
Geographic Area ◽  
Policy Changes ◽  
Rural Settings ◽  
Significant Difference ◽  
Geographic Setting ◽  
Unos Policy

Introduction: United Network for Organ Sharing (UNOS) recently extended the radius for which a heart transplant candidate can be matched with a donor in order to improve transplantation access for the most critically-ill patients. However, this means that smaller transplant centers serving rural populations may not retain the hearts that were donated within their geographic area. It is unknown whether the UNOS policy change of 2018 was associated with differences in likelihood of heart transplantation or death on the waiting list for patients from rural versus urban (metropolitan or micropolitan) settings. Methods: Using the Scientific Registry of Transplant Recipients, we analyzed U.S. adult patients who were listed for heart transplant from January 2017 through January 2020. Patients were stratified by home zipcodes to either metropolitan, micropolitan, or rural settings. Fine and Gray proportional hazard regression models were used to estimate the sub-distribution hazard ratio (SHR) of heart transplantation with death or removal from transplant list as a competing event according to geographic residence with date of UNOS policy change October 18 2018 as a time-varying covariate. Interaction (p-int) tests were performed between geographic setting and time of policy change. Results: Among 8756 patients, 82% were from metropolitan, 9% micropolitan, and 9% rural settings. The 2018 UNOS policy change was associated with increased receipt of heart transplantation within each geographic setting [metropolitan SHR 1.41 (95%CI: 1.33-1.50); micropolitan SHR 1.30 (95%CI: 1.08-1.56); rural SHR 1.33 (95%CI: 1.10-1.62); p-int=0.60]. Policy changes were not significantly associated with death on the transplant list for any geographic setting [metropolitan SHR 0.97 (95%CI: 0.82-1.14); micropolitan SHR 1.25 (95%CI: 0.80-1.96); rural SHR 0.89 (95%CI: 0.55-1.46); p-int=0.52]. Conclusions: Independent of geographic location, the 2018 UNOS policy change for heart transplantation was associated with increased heart transplantation and no significant difference in hazard of death. Additional follow-up is needed to determine whether improvements are sustained.

scholarly journals Evaluation of cardiomyopathy diagnosis in heart transplant recipients: comparison of echocardiographic and pathologic classification

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Neda Behzadnia ◽  
Babak Sharif-Kashani ◽  
Zargham Hossein Ahmadi ◽  
Farah Naghashzadeh ◽  
Atosa Dorudinia ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
Disease Process ◽  
Diagnostic Tools ◽  
Definite Diagnosis ◽  
Cross Sectional ◽  
Pathologic Diagnosis ◽  
Significant Difference ◽  
Pathologic Classification ◽  
Before And After

Abstract Background Definite diagnosis of cardiomyopathy types can be challenging in end-stage disease process. New growing data have suggested that there is inconsistency between echocardiography and pathology in defining type of cardiomyopathy before and after heart transplantation. The aim of the present study was to compare the pre-heart transplant echocardiographic diagnosis of cardiomyopathy with the results of post-transplant pathologic diagnosis. Results In this retrospective cross-sectional clinicopathological study, 100 consecutive patients have undergone heart transplantation in Masih-Daneshvari hospital, Tehran, Iran, between 2010 and 2019. The mean age of patients was 40 ± 13 years and 79% of patients were male. The frequency of different types of cardiomyopathy was significantly different between two diagnostic tools (echocardiography versus pathology, P < 0.001). On the other hand, in 24 patients, the results of echocardiography as regard to the type of cardiomyopathy were inconsistent with pathologic findings. Conclusion Based on the findings of the present study, it could be concluded that there is a significant difference between echocardiographic and pathologic diagnosis of cardiomyopathy; therefore, it is necessary to use additional tools for definite diagnosis of cardiomyopathy like advanced cardiac imaging or even endomyocardial biopsy before heart transplantation to reach an appropriate treatment strategy.

Geographic Distance From Transplant Center Does Not Impact Pediatric Heart Transplant Outcomes

2018 ◽  
Vol 28 (2) ◽  
pp. 170-173
Author(s):  
Meghann McKane ◽  
Debra A. Dodd ◽  
Bret A. Mettler ◽  
Kari A. Wujcik ◽  
Justin Godown
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
Blood Type ◽  
Transplant Recipients ◽  
Transplant Outcomes ◽  
Transplant Center ◽  
Significant Difference ◽  
Heart Transplant Recipients ◽  
The Impact ◽  
Pediatric Heart Transplant

Background: Many pediatric heart transplant recipients live a significant distance from their transplant center. This results in families either traveling long distances or relying on outside physicians to assume aspects of their care. Distance has been implicated to play a role in congenital heart disease outcomes, but its impact on heart transplantation has not been reported. The aim of this study was to assess the impact of distance on pediatric heart transplant outcomes. Methods: The Scientific Registry of Transplant Recipients database was queried for all pediatric heart transplant recipients from large US children’s hospitals (1987-2014). Patients were stratified into 4 groups (<20, 20-50, 50-100, and >100 miles) based on distance. Survival curves were generated and compared using the log-rank test. Cox proportional hazards regression was performed to adjust for differences between groups. Results: A total of 4768 patients were included in the analysis, of which 1435 (30.1%) were <20 miles, 940 (19.7%) were 20 to 50 miles, 806 (16.9%) were 50 to 100 miles, and 1587 (33.3%) were >100 miles from their transplant center. There was no difference in posttransplant survival based on distance after adjusting for patient age, gender, ethnicity, blood type, diagnosis, listing status, and the need for pretransplant ventricular assist device, extracorporeal membrane oxygenation, or ventilator support. Conclusion: There is no significant difference in graft survival after pediatric heart transplantation based on patient distance from their transplant center. Our data suggest the current strategy of transitioning some aspects of transplant care to local physicians or management from a distance does not increase posttransplant mortality risk.

Effect of UNOS policy change and exception status request on outcomes in patients bridged to heart transplant with an intra‐aortic balloon pump

2021 ◽  
Author(s):  
Aaron M. Wolfson ◽  
Eugene C. DePasquale ◽  
Vaughn A. Starnes ◽  
Mark Cunningham ◽  
Craig Baker ◽  
...  
Keyword(s):  
Policy Change ◽  
Heart Transplant ◽  
Intra Aortic Balloon Pump ◽  
Unos Policy

Abstract 182: Heart Transplantation Patients in the Medicare Population: Outcomes, Costs and Readmission Rates

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Fenton McCarthy ◽  
Desmond Graves ◽  
Danielle Savino ◽  
Amanda Chin ◽  
Danielle Spragan ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Hospital Length Of Stay ◽  
Fee For Service ◽  
Readmission Rates ◽  
Term Survival ◽  
Significant Difference

Objective: The average age of heart transplant recipients in the United States has been increasing over the past decade. The effect of age on outcomes following heart transplantation, including cost and readmission has yet to be thoroughly evaluated. Methods: All Medicare fee-for-service patients undergoing heart transplantation between 2008 and 2013 were included in the study. Denominator files were used to collect patient demographics and mortality. Kaplan-Meier survival estimates and Cox Proportional Hazards models were used for overall survival analysis. Results: A total of 4431 heart transplant patients were included in this study. Patients were broken down into categories of age <60, 60-69, and >70. Patients >70 were more likely to be male, white and have CAD and ischemic cardiomyopathy than patients <60. Multivariable cox survival model showed ECMO (HR 9.5, 95% CI 7.7 - 11.6, p < 0.01) and liver disease (HR 1.6 95% CI 1.2 - 2.2, p < 0.01) were associated with increased long-term mortality (p<0.01 and p=0.02, respectively). There was a significant difference in ECMO usage between patient groups with 6% of patents > 70, 4% of patients 60-69, and 3% of patients < 60 requiring ECMO (p=0.05). There was no significance was seen in 30 day mortality rates among between patients > 70 (5%) and patients < 70 years of age (5% ), p=0.83. Additionally, there was no difference between ICU lengths of stay, 30- and 90-day readmission rates (p=1.0 and p=0.72 respectively), and hospital length of stay (p=0.35) (Table 1). Conclusions: Among Medicare patients undergoing heart transplantation, those over the age of 70 had no difference in terms of survival and cost utilization compared to younger patients. Heart transplantation programs are doing a good job of selecting older patients in order to maintain these outcomes. Age was associated with increased use of ECMO, and ECMO adversely affected long-term survival.

Parties on the Left, Parties on the Right: Electoral Competition and Citizenship Policy Change in Europe

2020 ◽  
pp. 1-19
Author(s):  
John Graeber
Keyword(s):  
Policy Change ◽  
Spatial Competition ◽  
Electoral Competition ◽  
Party Competition ◽  
Policy Changes ◽  
Far Right ◽  
Left Party ◽  
Political Spectrum ◽  
The Right ◽  
Restrictive Policy

Abstract In recent decades, citizenship policies in Europe have changed significantly: some governments have introduced restrictive new requirements for citizenship, while others have made citizenship more accessible. What explains this variation? Despite a burgeoning literature on both comparative citizenship and spatial competition among parties, scholarship on this question remains in its infancy and primarily focused on the influence of the far right. Expanding on this growing research, this article argues that citizenship policy change results from electoral competition on both sides of the political spectrum, in conjunction with governments’ ideological orientation. Using new data on citizenship policies across sixteen European countries from 1975 to 2014, the author demonstrates that left-of-center governments facing increasing levels of left party competition are associated with more accessible policy changes, while increasing levels of party competition from the far right yield more restrictive policy changes under not only right-of-center governments, but also centrist and left-of-center governments as well.

scholarly journals COMPARISON OF SIX-MONTHS OUTCOMES IN PATIENTS BRIDGED TO HEART TRANSPLANT (HT) WITH INOTROPES BEFORE AND AFTER UNOS HEART ALLOCATION POLICY CHANGE

2020 ◽  
Vol 75 (11) ◽  
pp. 938
Author(s):  
Grace Liu ◽  
Eugene Christopher DePasquale ◽  
Joseph Rahman ◽  
Kruti Pandya ◽  
Darko Vucicevic ◽  
...  
Keyword(s):  
Policy Change ◽  
Heart Transplant ◽  
Allocation Policy ◽  
Before And After
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