From: Reuters
Published January 29, 2008 03:29 PM

More heart transplants needed for best results

NEW YORK (Reuters Health) - Patients who undergo heart transplant surgery in hospitals that perform 14 or more procedures each year achieve better outcomes than patients who undergo this procedure at hospitals that perform fewer heart transplants.

Recently, the U.S. Centers for Medicare and Medicaid Services, which qualifies hospitals for federal reimbursement, reduced the number of heart transplants needed to be considered a high-volume center from 12 to 10 per year. The current findings, however, indicate that the number should actually be increased to 14 procedures.

"Our national healthcare system has to rethink which hospitals should do heart transplants, and in consultation with their physicians, patients need to evaluate these surgical volumes to see for themselves which hospitals have teams operating at their peak skill level," senior author Dr. John Conte, from Johns Hopkins University, Baltimore, Maryland, said in a statement.

The study, presented today at the Society of Thoracic Surgeons meeting in Fort Lauderdale, Florida, involved 14,401 subjects who underwent heart transplantation in the U.S. between 1999 and 2006.

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The findings indicate that patient mortality at 30 days and at 1 year after a heart transplant increased as the annual procedure volume decreased. For instance, a center that performs more than 40 heart transplants per year has a patient mortality rate 30 days after surgery of less than 1 percent. In contrast, at centers with annual caseloads of less than 10, the 30-day mortality rate is increased by 80 percent.

The results, however, show a threshold effect. Once 14 cases per year were reached, each additional case had little impact on the risk of death.

According to the researchers, the bulk of the 143 US medical centers licensed to perform heart transplantations do fewer than 14 cases per year. Fewer than 10 centers do more than 30 heart transplantations per year and less than 5 do more than 40.

"In the U.S., too many low-volume hospitals have a program that they won't let go of, no matter how poor the results," study co-author Dr. Stuart Russell, also from Johns Hopkins, said in a statement.

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