Role of a regional heart failure (HF) unit in facilitating access to heart transplantation (HTx) in a non-HTx facility

Abstract

Introduction

Accessing heart transplantation (HTx) for patients with advanced heart failure (HF) can be difficult, especially in areas without local transplant centers. To address this issue, the University Hospital of Reims (UHR) has established a regional pathway within its HF unit since 2018.

Objective

To evaluate the effects of creating a dedicated HF unit on regional accessibility to HTx.

Method

This study utilized data from the Annual Medical and Scientific Report (RAMS) by the French Biomedicine Agency (ABM), covering the years 2014–2022. Three indicators of HTx activity in the former Champagne-Ardenne region were collected: the HTx listing rate per million inhabitants, the HTx transplantation rate per million inhabitants, and the cumulative 12-month HTx transplantation rate. Each indicator was transformed into a national index (the regional/national ratio) to adjust for annual variations. The trends from 2014 to 2022 were examined using regression analysis, and non-parametric tests assessed HTx activity before and after the establishment of the HF unit in 2018.

Results

Between 2014 and 2022, the median HTx-listing indicator was 1.04 (interquartile range (IQR): 0.95 to 1.22), showing a tendency to increase (P = 0.12) (Fig. 1). Notably, from 2019 to 2022, the median HTx-listing indicator significantly increased to 1.51 (IQR: 1.18 to 1.83), in contrast to 0.95 (IQR: 0.83 to 0.96) during 2014–2018 (P-value = 0.03) (Fig. 2A). The overall median HTx rate indicator was 1.29 (IQR: 1.15 to 1.60), with regression analysis indicating a non-significant upward trend (P-value = 0.0624) throughout the period (Fig. 1). In the 2019–2022 timeframe, the median HTx indicator notably rose to 1.61 (IQR: 1.57 to 1.63), compared to 0.95 (IQR: 0.58 to 1.15) during 2014–2018 (P-value = 0.02) (Fig. 2B). The overall median 12-month cumulative HTx indicator stood at 1.07 (IQR: 0.97 to 1.13), with regression analysis showing a statistically significant upward trend (P-value = 0.0095) over the full period (Fig. 1). Specifically, in the 2019–2022 period, the median 12-month cumulative HTx indicator significantly climbed to 1.14 (IQR: 1.11 to 1.17), as opposed to 0.97 (IQR: 0.96 to 1.00) during 2014–2018 (P-value = 0.032) (Fig. 2C).

Conclusion

The establishment of a dedicated Heart Failure (HF) unit within a non-Heart Transplant (HTx) facility has potentially increased the regional HTx accessibility, underscoring the importance of HF units in improving HTx access.