Thirty-Day Outcomes in Medicare Patients With Heart Failure at Heart Transplant Centers

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Abstract
Background— Heart transplant centers are generally considered “centers of excellence” for heart failure care. However, their overall performance has not previously been evaluated in a broad population of elderly patients with heart failure, many of whom are not transplant candidates. Methods and Results— We identified >1 million elderly Medicare beneficiaries who were hospitalized for heart failure between 2004 and 2006 at >4500 hospitals. We calculated 30-day risk-standardized mortality rates and standardized mortality ratios as well as 30-day risk-standardized readmission rates and standardized readmission ratios at heart transplant centers and non–heart transplant hospitals using risk-standardization models that the Centers for Medicare & Medicaid Services uses for public reporting. The 30-day risk-standardized mortality rates were lower at heart transplant centers than non–heart transplant hospitals nationally (10.6% versus 11.5%, P P =0.96). The mean standardized mortality ratio for heart transplant centers was 0.9 (SD, 0.1; range, 0.7 to 1.3). No differences were noted in 30-day risk-standardized readmission rates between heart transplant centers and non–heart transplant hospitals nationally (23.6% versus 23.8%, P =0.55). The mean standardized readmission ratio for heart transplant centers was 1.0 (SD, 0.1; range, 0.8 to 1.2). Conclusions— In elderly Medicare patients with heart failure, heart transplant centers have lower 30-day risk-standardized mortality rates than non–heart transplant hospitals nationally; however, this difference is not present in comparison with peer institutions or for 30-day risk-standardized readmission rates.

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