Thirty-day outcomes in Medicare patients with heart failure at heart transplant centers.

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. METHODS AND 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.