Selection of patients for heart transplantation in the current era of heart failure therapy.
OBJECTIVE
We sought to assess the relationship between survival, peak exercise oxygen consumption (VO(2)), and heart failure survival score (HFSS) in the current era of heart failure (HF) therapy.


BACKGROUND
Based on predicted survival, HF patients with peak VO(2) <14 ml/min/kg or medium- to high-risk HFSS are currently considered eligible for heart transplantation. However, these criteria were developed before the widespread use of beta-blockers, spironolactone, and defibrillators-interventions known to improve the survival of HF patients.


METHODS
Peak VO(2) and HFSS were assessed in 320 patients followed from 1994 to 1997 (past era) and in 187 patients followed from 1999 to 2001 (current era). Outcomes were compared between these two groups of patients and those who underwent heart transplantation from 1993 to 2000.


RESULTS
Survival in the past era was 78% at one year and 67% at two years, as compared with 88% and 79%, respectively, in the current era (both p < 0.01). One-year event-free survival (without urgent transplantation or left ventricular assist device) was improved in the current era, regardless of initial peak VO(2): 64% vs. 48% for peak VO(2) <10 ml/min/kg (p = 0.09), 81% vs. 70% for 10 to 14 ml/min/kg (p = 0.05), and 93% vs. 82% for >14 ml/min/kg (p = 0.04). Of the patients with peak VO(2) of 10 to 14 ml/min/kg, 55% had low-risk HFSS and exhibited 88% one-year event-free survival. One-year survival after transplantation was 88%, which is similar to the 85% rate reported by the United Network for Organ Sharing for 1999 to 2000.


CONCLUSIONS
Survival for HF patients in the current era has improved significantly, necessitating re-evaluation of the listing criteria for heart transplantation.
Department of Medicine, and Center for Health Services Research, Vanderbilt University Medical Center and Medicine Service, Nashville Veterans Affairs Medical Center, Tennessee 27232-6300, USA. javed.butler@vanderbilt.edu
Javed
J
Butler
Ghazanfar
G
Khadim
Kimberly M
KM
Paul
Stacy F
SF
Davis
Marvin W
MW
Kronenberg
Don B
DB
Chomsky
Richard N
RN
Pierson
John R
JR
Wilson
D000465:Algorithms; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015996:Survival Rate