Impact of the new heart allocation policy on patients with restrictive, hypertrophic, or congenital cardiomyopathies
Patients with restrictive or hypertrophic cardiomyopathy (RCM/HCM) and congenital heart disease (CHD) do not derive clinical benefit from inotropes and mechanical circulatory support. Concerns were expressed that the new heart allocation system implemented in October 2018 would disadvantage these pa...
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| creator | Chouairi, Fouad Mullan, Clancy W Sen, Sounok Mori, Makoto Fuery, Michael Elder, Robert W Lesse, Joshua Norton, Kelsey Clark, Katherine A Miller, P Elliott Mulligan, David Formica, Richard Rogers, Joseph G Jacoby, Daniel Maulion, Christopher Anwer, Muhammad Geirsson, Arnar Desai, Nihar R Ahmad, Tariq |
| description | Patients with restrictive or hypertrophic cardiomyopathy (RCM/HCM) and congenital heart disease (CHD) do not derive clinical benefit from inotropes and mechanical circulatory support. Concerns were expressed that the new heart allocation system implemented in October 2018 would disadvantage these patients. This paper aimed to examine the impact of the new adult heart allocation system on transplantation and outcomes among patients with RCM/HCM/CHD.
We identified adult patients with RCM/HCM/CHD in the United Network for Organ Sharing (UNOS) database who were listed for or received a cardiac transplant from April 2017-June 2020. The cohort was separated into those listed before and after allocation system changes. Demographics and recipient characteristics, donor characteristics, waitlist survival, and post-transplantation outcomes were analyzed.
The number of patients listed for RCM/HCM/CHD increased after the allocation system change from 429 to 517. Prior to the change, the majority RCM/HCM/CHD patients were Status 1A at time of transplantation; afterwards, most were Status 2. Wait times decreased significantly for all: RCM (41 days vs 27 days; P |
| doi_str_mv | 10.1371/journal.pone.0247789 |
| format | Article |
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We identified adult patients with RCM/HCM/CHD in the United Network for Organ Sharing (UNOS) database who were listed for or received a cardiac transplant from April 2017-June 2020. The cohort was separated into those listed before and after allocation system changes. Demographics and recipient characteristics, donor characteristics, waitlist survival, and post-transplantation outcomes were analyzed.
The number of patients listed for RCM/HCM/CHD increased after the allocation system change from 429 to 517. Prior to the change, the majority RCM/HCM/CHD patients were Status 1A at time of transplantation; afterwards, most were Status 2. Wait times decreased significantly for all: RCM (41 days vs 27 days; P<0.05), HCM (55 days vs 38 days; P<0.05), CHD (81 days vs 49 days; P<0.05). Distance traveled increased for all: RCM (76 mi. vs 261 mi, P<0.001), HCM (88 mi. vs 231 mi. P<0.001), CHD (114 mi vs 199 mi, P<0.05). Rates of transplantation were higher for RCM and CHD (P<0.01), whereas post-transplant survival remained unchanged.
The new allocation system has had a positive impact on time to transplantation of patients with RCM, HCM, and CHD without negatively influencing survival.]]></description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0247789</identifier><identifier>PMID: 33651802</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Biology and Life Sciences ; Cardiac patients ; Cardiology ; Cardiomyopathy ; Cardiomyopathy, Hypertrophic ; Cardiovascular diseases ; Congenital heart disease ; Congestive heart failure ; Coronary artery disease ; Data analysis ; Demographic aspects ; Editing ; Facilitated communication ; Health care facilities ; Health risks ; Heart ; Heart diseases ; Heart surgery ; Heart transplantation ; Hemodynamics ; Medicine ; Medicine and Health Sciences ; Methodology ; Patients ; Population studies ; Scandals ; Social aspects ; Social Sciences ; Surgery ; Survival analysis ; Transplantation ; Transplants & implants ; Variables ; Ventricle</subject><ispartof>PloS one, 2021-03, Vol.16 (3), p.e0247789-e0247789</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Chouairi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Chouairi et al 2021 Chouairi et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-b84793f65c1f07c0dd1276dcbb05244b72be715ebb2413f17bf00d4f7b2651783</citedby><cites>FETCH-LOGICAL-c692t-b84793f65c1f07c0dd1276dcbb05244b72be715ebb2413f17bf00d4f7b2651783</cites><orcidid>0000-0001-8715-6718 ; 0000-0002-2774-251X ; 0000-0001-9166-4838</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924739/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924739/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33651802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chouairi, Fouad</creatorcontrib><creatorcontrib>Mullan, Clancy W</creatorcontrib><creatorcontrib>Sen, Sounok</creatorcontrib><creatorcontrib>Mori, Makoto</creatorcontrib><creatorcontrib>Fuery, Michael</creatorcontrib><creatorcontrib>Elder, Robert W</creatorcontrib><creatorcontrib>Lesse, Joshua</creatorcontrib><creatorcontrib>Norton, Kelsey</creatorcontrib><creatorcontrib>Clark, Katherine A</creatorcontrib><creatorcontrib>Miller, P Elliott</creatorcontrib><creatorcontrib>Mulligan, David</creatorcontrib><creatorcontrib>Formica, Richard</creatorcontrib><creatorcontrib>Rogers, Joseph G</creatorcontrib><creatorcontrib>Jacoby, Daniel</creatorcontrib><creatorcontrib>Maulion, Christopher</creatorcontrib><creatorcontrib>Anwer, Muhammad</creatorcontrib><creatorcontrib>Geirsson, Arnar</creatorcontrib><creatorcontrib>Desai, Nihar R</creatorcontrib><creatorcontrib>Ahmad, Tariq</creatorcontrib><title>Impact of the new heart allocation policy on patients with restrictive, hypertrophic, or congenital cardiomyopathies</title><title>PloS one</title><addtitle>PLoS One</addtitle><description><![CDATA[Patients with restrictive or hypertrophic cardiomyopathy (RCM/HCM) and congenital heart disease (CHD) do not derive clinical benefit from inotropes and mechanical circulatory support. Concerns were expressed that the new heart allocation system implemented in October 2018 would disadvantage these patients. This paper aimed to examine the impact of the new adult heart allocation system on transplantation and outcomes among patients with RCM/HCM/CHD.
We identified adult patients with RCM/HCM/CHD in the United Network for Organ Sharing (UNOS) database who were listed for or received a cardiac transplant from April 2017-June 2020. The cohort was separated into those listed before and after allocation system changes. Demographics and recipient characteristics, donor characteristics, waitlist survival, and post-transplantation outcomes were analyzed.
The number of patients listed for RCM/HCM/CHD increased after the allocation system change from 429 to 517. Prior to the change, the majority RCM/HCM/CHD patients were Status 1A at time of transplantation; afterwards, most were Status 2. Wait times decreased significantly for all: RCM (41 days vs 27 days; P<0.05), HCM (55 days vs 38 days; P<0.05), CHD (81 days vs 49 days; P<0.05). Distance traveled increased for all: RCM (76 mi. vs 261 mi, P<0.001), HCM (88 mi. vs 231 mi. P<0.001), CHD (114 mi vs 199 mi, P<0.05). Rates of transplantation were higher for RCM and CHD (P<0.01), whereas post-transplant survival remained unchanged.
The new allocation system has had a positive impact on time to transplantation of patients with RCM, HCM, and CHD without negatively influencing survival.]]></description><subject>Biology and Life Sciences</subject><subject>Cardiac patients</subject><subject>Cardiology</subject><subject>Cardiomyopathy</subject><subject>Cardiomyopathy, Hypertrophic</subject><subject>Cardiovascular diseases</subject><subject>Congenital heart disease</subject><subject>Congestive heart failure</subject><subject>Coronary artery disease</subject><subject>Data analysis</subject><subject>Demographic aspects</subject><subject>Editing</subject><subject>Facilitated communication</subject><subject>Health care facilities</subject><subject>Health risks</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart surgery</subject><subject>Heart transplantation</subject><subject>Hemodynamics</subject><subject>Medicine</subject><subject>Medicine and Health 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Tariq</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the new heart allocation policy on patients with restrictive, hypertrophic, or congenital cardiomyopathies</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-03-02</date><risdate>2021</risdate><volume>16</volume><issue>3</issue><spage>e0247789</spage><epage>e0247789</epage><pages>e0247789-e0247789</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract><![CDATA[Patients with restrictive or hypertrophic cardiomyopathy (RCM/HCM) and congenital heart disease (CHD) do not derive clinical benefit from inotropes and mechanical circulatory support. Concerns were expressed that the new heart allocation system implemented in October 2018 would disadvantage these patients. This paper aimed to examine the impact of the new adult heart allocation system on transplantation and outcomes among patients with RCM/HCM/CHD.
We identified adult patients with RCM/HCM/CHD in the United Network for Organ Sharing (UNOS) database who were listed for or received a cardiac transplant from April 2017-June 2020. The cohort was separated into those listed before and after allocation system changes. Demographics and recipient characteristics, donor characteristics, waitlist survival, and post-transplantation outcomes were analyzed.
The number of patients listed for RCM/HCM/CHD increased after the allocation system change from 429 to 517. Prior to the change, the majority RCM/HCM/CHD patients were Status 1A at time of transplantation; afterwards, most were Status 2. Wait times decreased significantly for all: RCM (41 days vs 27 days; P<0.05), HCM (55 days vs 38 days; P<0.05), CHD (81 days vs 49 days; P<0.05). Distance traveled increased for all: RCM (76 mi. vs 261 mi, P<0.001), HCM (88 mi. vs 231 mi. P<0.001), CHD (114 mi vs 199 mi, P<0.05). Rates of transplantation were higher for RCM and CHD (P<0.01), whereas post-transplant survival remained unchanged.
The new allocation system has had a positive impact on time to transplantation of patients with RCM, HCM, and CHD without negatively influencing survival.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33651802</pmid><doi>10.1371/journal.pone.0247789</doi><tpages>e0247789</tpages><orcidid>https://orcid.org/0000-0001-8715-6718</orcidid><orcidid>https://orcid.org/0000-0002-2774-251X</orcidid><orcidid>https://orcid.org/0000-0001-9166-4838</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-03, Vol.16 (3), p.e0247789-e0247789 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2495372546 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Biology and Life Sciences Cardiac patients Cardiology Cardiomyopathy Cardiomyopathy, Hypertrophic Cardiovascular diseases Congenital heart disease Congestive heart failure Coronary artery disease Data analysis Demographic aspects Editing Facilitated communication Health care facilities Health risks Heart Heart diseases Heart surgery Heart transplantation Hemodynamics Medicine Medicine and Health Sciences Methodology Patients Population studies Scandals Social aspects Social Sciences Surgery Survival analysis Transplantation Transplants & implants Variables Ventricle |
| title | Impact of the new heart allocation policy on patients with restrictive, hypertrophic, or congenital cardiomyopathies |
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