Thirty-day outcomes in Medicare patients with heart failure at heart transplant centers

Abstract

Background: Heart transplant centers are generally considered "centers of excellence" for heart failure care. However, their overall performance has not previously been evaluated in a broad population of elderly patients with heart failure, many of whom are not transplant candidates.

Methods and results: We identified >1 million elderly Medicare beneficiaries who were hospitalized for heart failure between 2004 and 2006 at >4500 hospitals. We calculated 30-day risk-standardized mortality rates and standardized mortality ratios as well as 30-day risk-standardized readmission rates and standardized readmission ratios at heart transplant centers and non-heart transplant hospitals using risk-standardization models that the Centers for Medicare & Medicaid Services uses for public reporting. The 30-day risk-standardized mortality rates were lower at heart transplant centers than non-heart transplant hospitals nationally (10.6% versus 11.5%, P<0.001) but were similar at peer institutions offering coronary artery bypass grafting within the same geographical region (10.6% versus 10.6%, P=0.96). The mean standardized mortality ratio for heart transplant centers was 0.9 (SD, 0.1; range, 0.7 to 1.3). No differences were noted in 30-day risk-standardized readmission rates between heart transplant centers and non-heart transplant hospitals nationally (23.6% versus 23.8%, P=0.55). The mean standardized readmission ratio for heart transplant centers was 1.0 (SD, 0.1; range, 0.8 to 1.2).

Conclusions: In elderly Medicare patients with heart failure, heart transplant centers have lower 30-day risk-standardized mortality rates than non-heart transplant hospitals nationally; however, this difference is not present in comparison with peer institutions or for 30-day risk-standardized readmission rates.