Your browser doesn't support javascript.
loading
Effect of regional competition on heart transplant waiting list outcomes.
Nguyen, Vidang P; Givens, Raymond C; Cheng, Richard K; Mokadam, Nahush A; Levy, Wayne C; Stempien-Otero, April; Schulze, P Christian; Dardas, Todd F.
Afiliación
  • Nguyen VP; Division of Cardiology, University of Washington, Seattle, Washington, USA.
  • Givens RC; Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington, USA.
  • Cheng RK; Division of Cardiology, University of Washington, Seattle, Washington, USA.
  • Mokadam NA; Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington, USA.
  • Levy WC; Division of Cardiology, University of Washington, Seattle, Washington, USA.
  • Stempien-Otero A; Division of Cardiology, University of Washington, Seattle, Washington, USA.
  • Schulze PC; Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
  • Dardas TF; Division of Cardiology, University of Washington, Seattle, Washington, USA. Electronic address: tdardas@uw.edu.
J Heart Lung Transplant ; 35(8): 986-94, 2016 08.
Article en En | MEDLINE | ID: mdl-27230735
BACKGROUND: Heterogeneity of risk within heart transplant urgency designations is undesirable. Regional competition for donor hearts may contribute to this variation in risk. In this study we assessed whether an association exists between center competition and variation in event rates within status designations on the waiting list. METHODS: Our study sample included 20,237 adult transplant registrants initially listed between July 1, 2006 and July 1, 2013. Market competition was quantified using the Herfindahl-Hirshman Index (HHI) and number of centers within a donor service area (DSA) per 1 million people. A Cox model was used to assess for variation in waiting list outcomes within status designation by both HHI and DSA density. The primary outcome was death or delisting as too ill. RESULTS: Outcome rates within status designations differed significantly between centers: Status 1A, center p < 0.0001; Status 1B, center p < 0.0001; and Status 2, center p < 0.0001. Market competition (decreasing HHI) was associated with differential outcome rates within higher urgency status designation [Status 1A hazard ratio (HR) 0.94, p = 0.012; Status 1B HR 0.95, p = 0.010; and Status 2 HR 1.02, p = 0.360]. Center density within the DSA was not associated with outcome rates within each status designation (Status 1A HR 0.99, p = 0.961; Status 1B HR 1.03, p = 0.901; and Status 2 HR 1.20, p = 0.399). CONCLUSIONS: The rate of death or delisting as too ill within urgency designations varies between transplant centers and is partially explained by competition between transplant programs. Further methods of normalizing risk within status designations are necessary.
Asunto(s)
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Corazón Límite: Humans Idioma: En Revista: J Heart Lung Transplant Asunto de la revista: CARDIOLOGIA / TRANSPLANTE Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Corazón Límite: Humans Idioma: En Revista: J Heart Lung Transplant Asunto de la revista: CARDIOLOGIA / TRANSPLANTE Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos