Evidence map›Paper›PMID 35882595›Full record

ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2022

Relationships between 2018 UNOS heart policy and transplant outcomes in metropolitan, micropolitan, and rural settings.

Khadijah Breathett, Shannon M Knapp, Daniel Addison, Amber Johnson, Rashmee U Shah, Kelsey Flint, Harriette G C Van Spall, Nancy K Sweitzer, Sula Mazimba

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Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

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0cells of the map it votes in
4citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

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3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Khadijah BreathettDivision of Cardiovascular Medicine, Krannert Cardiovascular Institute, Indiana University, Indianapolis. Electronic address: kbreath@iu.edu.
Shannon M KnappStatistics Consulting Lab, Bio5 Institute, University of Arizona, Tucson.
Daniel AddisonDivision of Cardiovascular Medicine, Ohio State University.
Amber JohnsonDivision of Cardiovascular Medicine, University of Pittsburgh.
Rashmee U ShahDivision of Cardiovascular Medicine, University of Utah.
Kelsey FlintRocky Mountain Regional Veterans Affairs Medical Center, Cardiology Section and Division of Cardiovascular Medicine, University of Colorado.
Harriette G C Van SpallDepartment of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Nancy K SweitzerDivision of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson.
Sula MazimbaDivision of Cardiovascular Medicine, University of Virginia.

Funding

Seeking Objectivity in Allocation of Advanced Heart Failure (SOCIAL HF) Therapies TrialR01HL159216 · NHLBI · INDIANA UNIVERSITY INDIANAPOLIS · PI BREATHETT, KHADIJAH · 2022 to 2025
$2.6M
Seeking Objectivity in Allocation of Advanced Heart Failure (SOCIAL HF) Therapies TrialR56HL159216 · NHLBI · UNIVERSITY OF ARIZONA · PI BREATHETT, KHADIJAH · 2021 to 2021
$906k
Addressing Individual Provider Bias and Group Decision-Making in Selection of Advanced Heart Failure Therapies in Racial/Ethnic MinoritiesK01HL142848 · NHLBI · UNIVERSITY OF ARIZONA · PI BREATHETT, KHADIJAH · 2018 to 2021
$858k
NHLBI NIH HHS K01 HL142848NHLBI NIH HHS L30 HL148881NHLBI NIH HHS R01 HL159216NHLBI NIH HHS R56 HL159216
6 · The paper itself

Abstract

backgroundIn 2018, United Network for Organ Sharing (UNOS) extended the radius for which a heart transplant candidate can match with a donor, and outcomes across population densities are unknown. We sought to determine whether the policy change was associated with differences in heart transplant waitlist time or death post-transplant for patients from rural, micropolitan, and metropolitan settings.

methodsUsing the Scientific Registry of Transplant Recipients, we evaluated U.S. adult patients listed for heart transplant from Janurary 2017 to September 2019 with follow-up through March 2020. Patients were stratified by home zip-codes to either metropolitan, micropolitan, or rural settings. Fine and Gray and Cox models were respectively used to estimate Sub-distribution hazard ratios (SHR) of heart transplant with death or removal from transplant list as a competing event, and HR of death post-transplant within population densities after versus before the UNOS policy change date, October 18, 2018. Analyses were adjusted for demographics, comorbidities, and labs.

resultsAmong 8,747 patients listed for heart transplant, 84.7% were from metropolitan, 8.6% micropolitan, and 6.6% rural settings. The 2018 UNOS policy was associated with earlier receipt of heart transplant for metropolitan [SHR 1.56 (95% CI: 1.46-1.66)] and micropolitan [SHR 1.48 (95% CI: 1.21-1.82)] populations, but not significantly for rural [SHR 1.20 (95% CI: 0.93-1.54)]; however, the interaction between policy and densities was not significant (p = .14). Policy changes were not associated with risk of death post-transplant [metropolitan: HR 1.04 (95% CI: 0.80-1.34); micropolitan: HR 1.10 (95% CI: 0.55-2.23); rural: HR 1.04 (95% CI: 0.52-2.08); interaction p = .99].

conclusionsThe 2018 UNOS heart transplant policy was associated with earlier receipt of heart transplant and no difference in post-transplant survival within population densities. Additional follow-up is needed to determine whether improvements are sustained.

Indexed as

Heart TransplantationWaiting ListsAdultHumansPolicyProportional Hazards ModelsTissue DonorsHealthcare disparitiesHealth policyHeart transplantRural health centersSocioeconomic factors

Identifiers

PMID35882595
PMCPMC9489641

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.