Veteran Affairs Partnership Improves Access to High Volume, Quality Heart Transplant Programs. It Ain't Broke!

Abstract

Access to heart transplantation (HTX) within the Veteran Affairs Health Administration (VA) is an area of concern. In our study we examined the outcomes of veterans, often traveling great distances, undergoing HTX at Vanderbilt (VUMC) compared to non-veteran patients at the highest volume HTX VA-civilian partnership. Statistical analysis was performed on data gathered retrospectively from the EMR of 287 adult patients (VA=51, VUMC=236) who underwent isolated heart transplant at VUMC between January 2015 and December 2018 (Table 1) Multiple ordinal or binary logistic regressions for hospital length of stay, intensive care length of stay, and primary graft dysfunction were performed while adjusting for patients' age, preoperative VAD, PVR, donor ischemic times, and bypass time. Kaplan-Meier and Cox regression were used to evaluate the differences in the hazard of mortality between the groups at 1 year. A total of 312 patients underwent heart transplant; 3 were combined heart/liver (1VA and 2 VUMC), 21 were combined heart/kidney (1VA and 20 VUMC), and 287 were isolated heart transplants. VA patients from 14 states traveled significantly greater distances than non-VA patients (Table 1a)[p=0.001]. Multiple logistic regression model did not demonstrate statistically significant differences in ICU LOS (OR=0.95, CI=0.55-1.66, p=0.87), LOS (OR=1.02, 95%CI=0.59-1.77, p=0.94) or PGD (OR=0.92, 95%CI=0.42-2.04, p=0.84) (Table 1c). Kaplan-Meier plot showed no significant survival difference between VA and VUMC. On Cox regression analysis, the HR (risk of death) for site (VUMC vs. VA) was 2.0 (95% CI=0.25-15.9; p=0.51). Regionalization of care for cardiac transplantation within the VA system provides veterans with access to quality, specialized heart failure care that is comparable to the civilian population. Further analysis needs to be performed to determine if follow up patterns and long term survival differences exist between the two groups.