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Study Challenges New Benchmark for High-Volume Heart Transplant Hospitals

Johns Hopkins researchers question government decision to lower requirements for designation

WEDNESDAY, Jan. 30 (HealthDay News) -- Challenging a recent U.S. government decision to lower the benchmark for designation as a high-volume heart transplant hospital, a new Johns Hopkins Medical Institutions study reports the benchmark should instead increase, from 10 transplants to 14 transplants a year.

The Centers for Medicare and Medicaid Services, which qualifies medical centers for federal reimbursement, recently lowered the high-volume standard from 12 to 10 heart transplants per year.

"Our results clearly demonstrate that current standards have been arbitrarily set too low," senior investigator Dr. John Conte, director of heart and lung transplantation at The Johns Hopkins Hospital, said in a prepared statement. "There is a certain threshold, a minimum numbers of surgeries needed to maintain the expertise of the entire transplant team."

Each year, more than 2,000 people have a heart transplant in the United States.

In their study, the Hopkins team noted that high-volume centers consistently show higher survival and lower complication rates. They analyzed the records of 14,401 people who had heart transplants in the United States between 1999 and 2006, and found that death rates one month and one year after transplant increased steadily at hospitals that did fewer than 14 transplants per year.

The overall average death rate one year after heart transplant was 12.6 percent. But patients had a 16 percent greater risk of dying in a hospital that did fewer than five heart transplants per year. Patients who had a transplant at hospitals that did more than 40 heart transplants a year had the best chance of surviving.

Patients at hospitals that did less than 10 heart transplants a year had an 80 percent increased risk of dying within a month, compared to less than 1 percent for patients at hospitals that did more than 40 heart transplants per year.

Death rates flattened for the majority of patients in hospitals that did 14 or more heart transplants per year, the researchers found.

Roughly a dozen hospitals in the United States, including Johns Hopkins, perform at least 20 heart transplants a year, the researchers noted.

The study was presented Tuesday at the Society of Thoracic Surgeons annual meeting, in Fort Lauderdale, Fla.

More information

The U.S. National Heart, Lung, and Blood Institute has more about heart transplantation.

-- Robert Preidt

SOURCE: Johns Hopkins Medical Institutions, news release, Jan. 28, 2008

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