Survival on the Heart Transplant Waiting List
| Autor: | Syed Shahyan Bakhtiyar, Gabriel Loor, Abbas Rana, John A. Goss, Elizabeth L. Godfrey, Jeffrey A. Morgan, Whitson B. Etheridge, Faisal H. Cheema, Andrew B. Civitello, Harveen K. Lamba, Shayan Ahmed |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Tissue and Organ Procurement Waiting Lists Cross-sectional study medicine.medical_treatment MEDLINE 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans 030212 general & internal medicine Registries Survival analysis Retrospective Studies Original Investigation Heart transplantation Heart Failure business.industry Retrospective cohort study Transplant Waiting List Middle Aged United States Transplantation Survival Rate Cross-Sectional Studies Ventricular assist device Emergency medicine Heart Transplantation Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | JAMA Cardiol |
| ISSN: | 2380-6591 |
| Popis: | IMPORTANCE: With continuing improvements in medical devices and more than a decade since the 2006 United Network for Organ Sharing (UNOS) allocation policy, it is pertinent to assess survival among patients on the heart transplantation waiting list, especially given the recently approved 2018 UNOS allocation policy. OBJECTIVES: To assess survival outcomes among patients on the heart transplant waiting list during the past 3 decades and to examine the association of ventricular assist devices (VADs) and the 2006 UNOS allocation policy with survival. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cross-sectional used the UNOS database to perform an analysis of 95 323 candidates wait-listed for heart transplantation between January 1, 1987, and December 29, 2017. Candidates for all types of combined transplants were excluded (n = 2087). Patients were followed up from the time of listing to death, transplantation, or removal from the list due to clinical improvement. Competing-risk, Kaplan-Meier, and multivariable Cox proportional hazards regression analyses were used. MAIN OUTCOMES AND MEASURES: The analysis involved an unadjusted and adjusted survival analysis in which the primary outcome was death on the waiting list. Because of changing waiting list preferences and policies during the study period, the intrinsic risk of death for wait-listed candidates was assessed by individually analyzing, comparing, and adjusting for several candidate risk factors. RESULTS: In total, 95 323 candidates (72 915 men [76.5%]; mean [SD] age, 51.9 [12.0] years) were studied. In the setting of changes in listing preferences, 1-year survival on the waiting list increased from 34.1% in 1987-1990 to 67.8% in 2011-2017 (difference in proportions, 0.34%; 95% CI, 0.32%-0.36%; P |
| Databáze: | OpenAIRE |
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