Advancing patient-centered metrics for heart transplantation: The role of days alive and outside the hospital.
Recommended Citation
Pegues JN, Fawaz RM, Kimfon KM, Hou H, Noly PE, Cascino TM, Hawkins RB, Stewart Ii JW, Aaronson K, Cowger J, Pagani FD, and Likosky DS. Advancing Patient-Centered Metrics for Heart Transplantation: The Role of Days Alive and Outside the Hospital. J Heart Lung Transplant 2024.
Document Type
Article
Publication Date
11-15-2024
Publication Title
The Journal of heart and lung transplantation
Abstract
BACKGROUND: Heart transplantation (HT) survival and waitlist times are established outcome metrics. Patient-centered HT outcomes are insufficiently characterized. This study evaluates the role of days alive and outside the hospital (DAOH) as a candidate patient-centered HT performance measure.
METHODS: The study cohort included Medicare beneficiaries undergoing HT (July 2008-December 2017). The percent of days outside of hospital (%DOH) 6 months before (%DOH-BF) and percent of days alive outside of hospital 12 months after HT (%DAOH-AF) were evaluated along with adverse events (AEs, early: ≤3 months; late: 4-12 months). Patients were stratified by patient %DAOH-AF terciles. Risk-adjusted %DAOH was evaluated across hospitals.
RESULTS: A total of 5,104 beneficiaries underwent HT across 108 hospitals. Median [IQR] age was 62 [53-67] years, 23.9% were female, and 21.4% were African-American. The overall median %DOAH-AF was 92.9% [83.8%, 95.9%], varying by tercile: low: 71.8% [4.9%, 83.6%], intermediate; 92.9% [91%, 94%]; high 96.4% [95.9%, 97.3%]. The lowest (versus highest) tercile %DAOH-AF had a lower median %DOH-BF (88% [73%-97%] versus 92% [81%-98%]) and longer post-HT inpatient stay (54 [36-81] versus 13 [10-15] days). After HT, the lowest versus highest tercile had greater AEs burden in the early [allograft failure (16.1% versus 1.6%), stroke (12.1% versus 2.3%)], and late [stroke (5.1% versus 1.9%), sternal wound infection (5.0% versus 0.8%)] phases post-HT. Mean hospital %DAOH(adj) was 80.5% (min:max 57.7%-96.7%).
CONCLUSIONS: Post-HT %DAOH varies across beneficiaries and hospitals and is associated with AEs. Further research is warranted to assess the role and validity of %DAOH as an HT quality metric.
PubMed ID
39551172
ePublication
ePub ahead of print
