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Does distance between home and transplantation center adversely affect patient outcomes after heart transplantation?
S M Rodkey1, R E Hobbs, M Goormastic
1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Long-distance heart transplant care is safe and effective, with no increased adverse outcomes. Maintaining local physician contact improves survival rates for heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Services Research
Background:
- Managed care programs increasingly lead to long-distance consultations for heart transplantation.
- This study examines the impact of patient distance from the transplant center on outcomes.
Purpose of the Study:
- To assess the effect of geographic distance on heart transplant recipient outcomes.
- To determine if long-distance care impacts adverse events or survival.
Main Methods:
- Retrospective review of 312 adult heart transplant recipients surviving at least 3 months.
- Analysis of 10 adverse events, including rejection, infection, and death, across three distance groups (0-150, 151-300, >300 miles).
- Assessment of local physician involvement and its correlation with outcomes.
Main Results:
- No significant differences in follow-up duration, biopsy rates, or adverse events (rejection, ED visits, admissions, vasculopathy) were found based on distance.
- Death/retransplantation rates at 3 years were similar across all distance groups (84.5% to 94.0%).
- Patients with a local physician alongside transplant care showed significantly better 3-year survival (90.7% vs. 72.6%).
Conclusions:
- Long-distance management of heart transplant recipients is a viable and safe strategy.
- Geographic distance alone should not be a barrier to heart transplantation.
- Encouraging local physician involvement is crucial for optimizing long-term survival in heart transplant patients.
Background:
The emergence of heart transplantation referral centers, in an era of cost-conscious managed care programs, frequently leads to long-distance patient consultation and care. The purpose of this project was to review one center's experience regarding the effect of long distances from home to transplantation hospital on outcomes.
Methods:
Three hundred twelve adult, noninternational, transplant recipients surviving at least 3 months were assessed for 10 events: rejection episodes, number of endomyocardial biopsies, emergency department visits, hospital admissions, return to full-time work or school, infections, coronary allograft vasculopathy, malignancies, retransplantation, and death. Presence of a locally involved physician was also determined. Distance from the transplantation center was analyzed in three discrete groups: 0 to 150 miles (n = 207), 151 to 300 miles (n = 69), and >300 miles (n = 36).
Results:
There were no differences among the groups in mean length of follow-up (40.6, 36.9, 39.0 months, p = 0.27) or number of biopsies (20.5 +/- 0.16, 18.3 +/- 1.1, 18.0 +/- 1.1, p = 0.07). As the distance increased from the transplantation center, there was no greater incidence of adverse outcomes. Cellular rejection was the same among the groups (45%, 45%, 36%, p = 0.58). Likewise, emergency department visits and hospital admissions also did not vary: (9.7%, 5.8%, 8.3%, p = 0.61) and (22.2%, 13.0%, 16.7%, p = 0.23, respectively). There were no differences in the incidence of coronary vasculopathy (9.2%, 11.6%, 13.9%, p = 0.63). More importantly, the three groups did not differ in death/retransplantation rates (3-year survival, 84.5, 94.0 and 86.9, p = 0.14). Patients cared for by a local physician in addition to their transplant cardiologist had better survival rates than patients without a local physician (3-year survival rate, 90.7 vs 72.6, p = 0.0008).
Conclusions:
Long-distance management of heart transplant recipients is successful and is not associated with an increase in adverse outcomes. By itself, distance should not represent a contraindication to transplantation. Patients should be encouraged to maintain contact with a local physician, in addition to the regularly scheduled visits at the transplantation center.