Post-transplant survival and rehospitalization for Medicare heart transplant patients

Heart transplantation has become an effective, standard treatment for end-stage heart failure patients. Improvements in patient\donor selection, immunosuppression and surgical procedures have improved outcomes and made transplantation a possible option for older patients and diabetics with end-stage heart disease. Prior studies have found 1 year survival rates exceeding 80% for several populations. Long-term survival (10 years or greater) is likely for a majority of heart transplant patients. Survival rates for heart transplant patients under Medicare and the subsequent service use patterns of Medicare heart transplant patients have not been examined to date. This study examines survival rates and post-transplant hospitalizations for Medicare beneficiaries receiving heart transplants.

MEDPAR discharge data are examined for Medicare fee-for-service beneficiaries who received a heart transplant (DRG 103) during CY 2002 (N=597). Demographic data for this group are presented. Survival rates at discharge and at 1 - 5 years post discharge are presented. Post-transplant hospitalizations are obtained from CY 2002 - 2007 MEDPAR discharge data. The percent hospitalized in each year is presented as are the total number of hospitalizations and number of hospitalizations for cardiovascular surgical and medical conditions.

The heart transplant patients examined were 77% male and averaged 57 years of age. Only 30% were age 65 or older. The patients ranged from 21 to 76 years of age. Slightly over 80% of heart transplant patients were white and 13.6% were black. Nearly 17% of these patients also had diabetes and 22.4% had hypertension. Only 9.2% of the patients selected died during their hospitalization. Over 85% of the patients in this study survived 1 year post-discharge, 77.7% survived 3 years post-discharge and 73.5% survived 5 years post-discharge. Nearly 80% of this group of patients (n=477) were hospitalized during the period from discharge after transplant to 12/31/2007. They averaged 5 hospitalizations and 34 days of care during this period. Only 30% of these hospitalizations were for cardiovascular conditions (nearly exclusively medical). Nearly 42% of the study group (n=250) were rehospitalized after their transplant in 2002, 47% (n=280) were hospitalized during 2003, 34.6% (n=207) were hospitalized during 2004, 29% (n=172) were hospitalized during 2005, 28% (n=168) were hospitalized during 2006 and 18.6% (n=111) were hospitalized during 2007. The majority of hospital stays were for non-cardiovascular conditions. Most Medicare heart transplant patients were likely to survive several years after transplant even though a significant percent are hospitalized in the 5 year period following transplant.