title: Thirty-day outcomes in Medicare patients with heart failure at heart transplant centers.
abstract: BACKGROUND
  Heart transplant centers are generally considered "centers of excellence" for heart failure care. However, their overall performance has not previously been evaluated in a broad population of elderly patients with heart failure, many of whom are not transplant candidates.
  
  
  RESULTS
  We identified >1 million elderly Medicare beneficiaries who were hospitalized for heart failure between 2004 and 2006 at >4500 hospitals. We calculated 30-day risk-standardized mortality rates and standardized mortality ratios as well as 30-day risk-standardized readmission rates and standardized readmission ratios at heart transplant centers and non-heart transplant hospitals using risk-standardization models that the Centers for Medicare & Medicaid Services uses for public reporting. The 30-day risk-standardized mortality rates were lower at heart transplant centers than non-heart transplant hospitals nationally (10.6% versus 11.5%, P<0.001) but were similar at peer institutions offering coronary artery bypass grafting within the same geographical region (10.6% versus 10.6%, P=0.96). The mean standardized mortality ratio for heart transplant centers was 0.9 (SD, 0.1; range, 0.7 to 1.3). No differences were noted in 30-day risk-standardized readmission rates between heart transplant centers and non-heart transplant hospitals nationally (23.6% versus 23.8%, P=0.55). The mean standardized readmission ratio for heart transplant centers was 1.0 (SD, 0.1; range, 0.8 to 1.2).
  
  
  CONCLUSIONS
  In elderly Medicare patients with heart failure, heart transplant centers have lower 30-day risk-standardized mortality rates than non-heart transplant hospitals nationally; however, this difference is not present in comparison with peer institutions or for 30-day risk-standardized readmission rates.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich 48109-5853, USA. scothumm@med.umich.edu
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hummel
authors.forename: Natalie P
authors.initials: NP
authors.lastname: Pauli
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000704:Analysis of Variance; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D016027:Heart Transplantation; D006782:Hospitals, Special / Q000592:standards*; D006801:Humans; D016014:Linear Models; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data; D012306:Risk; D014481:United States / Q000453:epidemiology