Eastern Cardiothoracic Surgical Society

Patient Age, Cost and Readmission of Heart Transplantation in the U.S. Medicare Population
Amanda L. Chin, Danielle Savino, Danielle Spragan, Fenton H. McCarthy, Taylor Dibble, Ashley Hoedt, Katherine McDermott, Keith Dufendach, Peter Groeneveld, Joseph Bavaria, Wilson Szeto, Nimesh D. Desai,  University of Pennsylvania, Philadelphia, PA

OBJECTIVE: Given the increasing number of heart transplants performed in patients over age 70, it is important to assess the costs, readmission rates and long-term outcomes in these patients.

METHODS: All Medicare fee-for-service patients undergoing heart transplantation between 2008 and 2013 were identified using the International Classification of Diseases, Ninth Revision (ICD-9) 37.51 procedure code. Denominator files were used to collect patient demographics and mortality. A modified Elixhauser comorbidity index was used to identify comorbidities present on index hospitalization using ICD-9 diagnosis codes.

RESULTS: A total of 4,431 heart transplant patients were included in this study. Patients were broken down into categories of age <60, 60-69 and >70. Patients >70 were more likely to be male and have hypertension, PVD, and renal failure than patients <60, but less likely to have liver disease. In hospital mortality rates of patients <60 were significantly lower than patients 60-69 or >70 (5% vs. 7% vs. 7%, p=0.03). No difference in long-term mortality was seen in Kaplan-Meier survival estimates between age categories (Figure SA-11-1, p=0.27). No significant difference was seen in hospital length of stay or index hospitalization costs. 30 and 90-day readmission rates were also similar between age categories. Multivariate Cox regression models indicate that predictors of long-term mortality include hypertension and liver disease, but not age (Table SA11-1).

CONCLUSIONS: There appears to be no significant difference in costs, readmission rates or long-term outcomes following heart transplants between different age categories. Thus, heart transplantation may remain a viable option for heart failure patients over age 70.

Table SA-11-1. Cox Survival Model of Heart Transplant Recipients

Hazard Ratio Lower 95% CI Upper 95% CI p
Male 1.018 0.858 1.206 0.841
Age 1.004 0.997 1.011 0.2924
White 0.855 0.729 1.001 0.0521
Vavlular Disease 0.883 0.755 1.033 0.1194
PVD 1.087 0.845 1.398 0.5181
COPD 0.894 0.741 1.078 0.2415
Renal Failure 0.967 0.828 1.128 0.6665
Liver Disease 1.745 1.299 2.344 0.0002
Hypertension 1.187 1.012 1.393 0.0354