Discrepancies in access and institutional risk tolerance in heart transplantation: A national open cohort study

Area of Science:

• Cardiology
• Transplant Surgery
• Health Services Research

Background:

• Center volume is a recognized benchmark in heart transplantation for certification and reimbursement.
• Understanding factors influencing access to high-volume centers is crucial for equitable care.

Purpose of the Study:

• To investigate sociodemographic variables associated with accessing high-volume heart transplant centers.
• To emphasize the importance of expanding access to these specialized centers for underserved patient groups.

Main Methods:

• Analysis of adult heart transplant data from 2006-2015, involving 18,725 patients across 145 centers.
• Centers categorized into terciles based on annual transplant volume (<14, 14-25, >25 transplants).
• Multinomial regression used to identify factors associated with receiving care at different volume centers.

Main Results:

• Younger age, lower education, and government insurance were linked to lower odds of care at high-volume centers.
• High-volume centers managed higher-risk recipients and accepted organs from higher-risk donors.
• Care at high- and intermediate-volume centers correlated with improved 1-year survival compared to low-volume centers.

Conclusions:

• Access to high- and intermediate-volume heart transplant centers is influenced by social, demographic, and geographic factors.
• High-volume centers demonstrate capacity to manage increased risk while achieving excellent patient survival outcomes.
• Increased awareness of these access disparities should drive efforts to extend care to underserved populations.