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Date: March 27, 1995 FOR IMMEDIATE RELEASE Contact: Anne Verano, HCFA (202) 690-6145
A HCFA study concludes that heart transplant patients at Medicare- approved centers have a 20 percent lower risk of dying within 30 days of receiving the procedure, and that this difference continues over the following five years.
According to the study, the difference in survival outcome between Medicare and non-Medicare approved transplant centers is not attributable to the numerous patient demographic or medical risk factors encountered in heart transplantation.
"The results of this study suggest that setting up medical centers of excellence, which treat a high volume of transplant patients, produces better outcomes for those patients," said HCFA Administrator Bruce C. Vladeck, who oversees the Medicare program. "This is another validation of our approach to centers of excellence."
The study found that the probability of death for patients receiving a heart transplant at a facility not approved by Medicare is 9.2 percent within 30 days and 19.2 percent within one year, compared with 7 percent within 30 days and 16.2 percent within one year for those treated at a Medicare-approved transplant center.
The researchers found that the difference in mortality is largely due to the higher incidence of non-specific graft failure among patients getting heart transplants in non-Medicare approved facilities. Non-specific graft failure refers to transplantation failure arising from inherent defects or non-viability of the donor organ, as opposed to infection or organ rejection.
The study says that data were unavailable to determine the specific factors relating to the organ's condition, surgical technique or organ preservation management that resulted in this difference in non-specific graft failure.
The study was published today in Transplantation, the journal of the Transplantation Society, which includes the American Society of Transplantation Physicians, the American Society of Transplantation Surgeons and the International Transplantation Society.
To date, 73 hospitals and medical centers in 31 states and the District of Columbia have been approved by Medicare to perform heart transplants on Medicare beneficiaries.
Medicare-approved medical centers must meet extensive criteria set out by HCFA and a review board comprised of transplant surgeons, cardiologists and other clinicians and scientists. A facility must have Medicare-approval status before it can receive payment from HCFA for heart transplantation services for Medicare beneficiaries.
The study reviewed 9,401 heart transplants performed in 140 U.S. medical centers between 1986 and 1991. (By the end of 1991, Medicare had given approval to 51 heart transplant centers. In addition, the percentage of the surveyed heart transplants performed in these approved centers had increased from 8.2 percent in 1986 to 65.5 percent in 1991.)
The study's authors are Henry Krakauer, M.D., Ph.D., Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Md.; Sam S. Shekar, M.D., M.P.H., HCFA; and Michael P. Kaye, M.D., International Society for Heart and Lung Transplantation Registry, Minneapolis, Minn.
Note to Editors: A list of the current approved heart transplant centers, including year of Medicare's approval, alphabetical by state, is attached.
The criteria require facilities to have an established cardiac transplantation program with documented experience. For example, a facility would have had to perform 12 or more transplants in each of the two preceding years, and 12 transplants prior to that, with an average one-year survival rate of 73 percent and a two-year rate of 65 percent.
The criteria also require facilities to have a patient selection process. These processes are generally based on a critical medical need for a transplant and a maximum likelihood of survival.
HCFA's patient selection guidelines include that the patient evaluation must indicate a very poor prognosis--for example, less than 25 percent likelihood of survival for six months--without the transplant, and that all other approved medical and surgical therapies must have been tried or considered.
Alabama University Hospital University of Alabama, Birmingham (approved in 1986). Arizona University Medical Center at the Arizona Health Sciences Center Tucson (1986). California Stanford University Hospital Stanford University Medical Center, Stanford (1986); California Pacific Medical Center San Francisco (1987); Los Angeles Medical Center University of California, Los Angeles (1989); Sharp Memorial Hospital San Diego (1989); Cedars-Sinai Medical Center Los Angeles (1992); University of California San Diego (1994). Colorado University Hospital Colorado, Denver (1992). Connecticut Hartford Hospital Hartford (1989); Yale-New Haven Medical Center New Haven (1991). District of Columbia Washington Hospital Center Washington, D.C. (1992). Florida Tampa General Hospital Tampa (1988); Shands Hospital University of Florida, Gainesville (1990). Georgia St. Joseph's Hospital Atlanta (1989); Emory University Hospital (Robert W. Woodruff Health Sciences Center), Atlanta (1990). Illinois Foster G. McGaw Hospital Loyola University Medical Center, Maywood (1986); St. Francis Medical Center Peoria (1992). Indiana Methodist Hospital of Indiana Indianapolis (1986); Northern Indiana Heart Institute (Lutheran Hospital of Fort Wayne), Fort Wayne (1990); Indiana University Hospitals Indianapolis (1990). Kansas St. Francis Regional Medical Center Wichita (1993). Kentucky Jewish Hospital Louisville (1988). Louisiana Ochsner Foundation Hospital New Orleans (1990); Willis-Knighton Medical Center Louisiana State University, Shreveport (1994). Maryland The Johns Hopkins Hospital Baltimore (1986). Massachusetts Brigham and Women's Hospital Boston (1987); Massachusetts General Hospital Boston (1992). Michigan Henry Ford Hospital Detroit (1988); University of Michigan Medical Center University of Michigan Hospitals, Ann Arbor (1990). Minnesota University of Minnesota Hospital and Clinic Minneapolis (1986); Abbott-Northwestern Hospital Minneapolis (1990); Mayo Clinic (St. Mary's Hospital) Rochester (1993). Missouri St. Louis University Hospital St. Louis (1986); Washington University (Barnes Hospital) St. Louis (1987); St. Luke's Hospital of Kansas City Kansas City (1990); University of Missouri Hospitals and Clinics Columbia (1994). New Mexico Presbyterian Hospital Albuquerque (1990). New York Columbia-Presbyterian Medical Center New York City (1989); Mount Sinai Medical Center New York City (1994). North Carolina The Carolinas Heart Institute Charlotte (1989); Duke University Medical Center Durham (1992); University of North Carolina Hospitals Chapel Hill (1994). Ohio The Cleveland Clinic Foundation Cleveland (1988); Ohio State University Heart Transplant Program, Columbus (1989); University of Cincinnati Medical Center Cincinnati (1991). Oklahoma Baptist Medical Center Oklahoma City (1989). Oregon The Oregon Health Sciences University Portland (1988). Pennsylvania Presbyterian University Hospital Pittsburgh (1986); Temple University Hospital Philadelphia (1987); M.S. Hershey Medical Center The Pennsylvania State University, Hershey (1989); Hospital of the University of Pennsylvania Philadelphia (1991); Allegheny General Hospital Pittsburgh (1992). South Carolina Medical University of South Carolina Charleston (1992). Tennessee Vanderbilt University Medical Center Nashville (1989); St. Thomas Hospital Nashville (1992). Texas Methodist Hospital/Baylor College of Medicine The Methodist Hospital System, Houston (1986); St. Luke's Episcopal Hospital (Texas Heart Institute), Houston (1986); Baylor University Medical Center Dallas (1990); Humana Hospital San Antonio San Antonio (1990); St. Paul Medical Center Dallas (1992). Utah University Hospital University of Utah, Salt Lake City (1986); Latter Day Saints Hospital Salt Lake City (1988). Virginia Medical College of Virginia Richmond (1986); Fairfax Hospital Falls Church (1991); Sentara Norfolk General Hospital Norfolk (1992); University of Virginia Health Sciences Center Charlottesville (1993); Henrico Doctor's Hospital Richmond (1994). Washington University of Washington Seattle (1989); Sacred Heart Medical Center Spokane (1993). Wisconsin St. Luke's Medical Center Milwaukee (1990); University of Wisconsin Hospitals Madison (1991).