Is it time for a cardiac allocation score? First results from the Eurotransplant pilot study on a survival benefit-based heart allocation
Standard
Is it time for a cardiac allocation score? First results from the Eurotransplant pilot study on a survival benefit-based heart allocation. / Smits, Jacqueline M; de Vries, Erwin; De Pauw, Michel; Zuckermann, Andreas; Rahmel, Axel; Meiser, Bruno; Laufer, Guenther; Reichenspurner, Hermann; Strueber, Martin.
in: J HEART LUNG TRANSPL, Jahrgang 32, Nr. 9, 09.2013, S. 873-880.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Is it time for a cardiac allocation score? First results from the Eurotransplant pilot study on a survival benefit-based heart allocation
AU - Smits, Jacqueline M
AU - de Vries, Erwin
AU - De Pauw, Michel
AU - Zuckermann, Andreas
AU - Rahmel, Axel
AU - Meiser, Bruno
AU - Laufer, Guenther
AU - Reichenspurner, Hermann
AU - Strueber, Martin
N1 - Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
PY - 2013/9
Y1 - 2013/9
N2 - BACKGROUND: Patients awaiting heart transplantation in Eurotransplant are prioritized by waiting time and medical urgency. To reduce mortality, the introduction of post-transplant survival in an allocation model based on the concept of survival benefit might be more appropriate. The aim of this study was to assess the prognostic accuracy of the heart failure survival score (HFSS), the Seattle heart failure model (SHFM), the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) model, and the index for mortality prediction after cardiac transplantation (IMPACT) score for predicting mortality.METHODS: The HFSS, SHFM, the adapted SHFM, and the INTERMACS model were evaluated for predicting waiting list mortality among heart transplant candidates, and the IMPACT score was tested for predicting post-transplant mortality in separate Cox regression models. Included were the 448 adult heart transplant candidates listed for an urgent status between October 2010 and June 2011 in Eurotransplant. A cardiac allocation score (CAS) was calculated based on the estimated survival times as predicted by the scores. All analyses were performed for the total cohort and separately for ventricular assist device (VAD) and non-VAD patients.RESULTS: Mortality on the waiting list could significantly be predicted in the non-VAD cohort by HFSS (p = 0.005) and SHFM (p < 0.0001) and after transplant by IMPACT (p < 0.0001). None of the tested scores could predict mortality among VAD-supported patients.CONCLUSIONS: In non-VAD patients, the HFSS, SHFM, and IMPACT provide accurate risk stratification. Further studies will reveal whether these models should be considered as the basis for a new heart allocation policy in Eurotransplant.
AB - BACKGROUND: Patients awaiting heart transplantation in Eurotransplant are prioritized by waiting time and medical urgency. To reduce mortality, the introduction of post-transplant survival in an allocation model based on the concept of survival benefit might be more appropriate. The aim of this study was to assess the prognostic accuracy of the heart failure survival score (HFSS), the Seattle heart failure model (SHFM), the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) model, and the index for mortality prediction after cardiac transplantation (IMPACT) score for predicting mortality.METHODS: The HFSS, SHFM, the adapted SHFM, and the INTERMACS model were evaluated for predicting waiting list mortality among heart transplant candidates, and the IMPACT score was tested for predicting post-transplant mortality in separate Cox regression models. Included were the 448 adult heart transplant candidates listed for an urgent status between October 2010 and June 2011 in Eurotransplant. A cardiac allocation score (CAS) was calculated based on the estimated survival times as predicted by the scores. All analyses were performed for the total cohort and separately for ventricular assist device (VAD) and non-VAD patients.RESULTS: Mortality on the waiting list could significantly be predicted in the non-VAD cohort by HFSS (p = 0.005) and SHFM (p < 0.0001) and after transplant by IMPACT (p < 0.0001). None of the tested scores could predict mortality among VAD-supported patients.CONCLUSIONS: In non-VAD patients, the HFSS, SHFM, and IMPACT provide accurate risk stratification. Further studies will reveal whether these models should be considered as the basis for a new heart allocation policy in Eurotransplant.
KW - Adolescent
KW - Adult
KW - Aged
KW - Cohort Studies
KW - Europe/epidemiology
KW - Female
KW - Heart Failure/epidemiology
KW - Heart Transplantation/mortality
KW - Humans
KW - Male
KW - Middle Aged
KW - Models, Statistical
KW - Pilot Projects
KW - Prognosis
KW - Regression Analysis
KW - Resource Allocation/standards
KW - Risk Assessment
KW - Severity of Illness Index
KW - Survival Rate
KW - Waiting Lists/mortality
KW - Young Adult
U2 - 10.1016/j.healun.2013.03.015
DO - 10.1016/j.healun.2013.03.015
M3 - SCORING: Journal article
C2 - 23628111
VL - 32
SP - 873
EP - 880
JO - J HEART LUNG TRANSPL
JF - J HEART LUNG TRANSPL
SN - 1053-2498
IS - 9
ER -
