Date: March 27, 1995
FOR IMMEDIATE RELEASE
Contact: Anne Verano, HCFA (202) 690-6145

HCFA Study Shows Higher Survival Rate
for Heart Transplants Performed
at Medicare-Approved Hospitals, Medical Centers

Patients receiving heart transplants at medical facilities that meet Medicare standards have a higher survival rate, the Health Care Financing Administration announced today.

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.

Attachment
The criteria used by HCFA for selection of heart transplant centers are intended to ensure that approval is given only to facilities with the necessary experience and expertise to perform this complex surgery successfully.

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.

Medicare Heart Transplant Centers

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).

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