Heart failure & cardiomyopathiesCohort study
Association of the 2018 U.S. Heart Allocation Policy Change and the Survival Benefit of Heart Transplantation
- Observational cohort study
- seasonally matched cohort
- mixed-effects Cox proportional hazards model
Authors' conclusion
The 2018 heart allocation policy change has led to better stratification and prioritization of candidates by clinical acuity, resulting in higher survival benefit of transplantation performed.
Study context
- Population
- US adult heart transplant candidates, 111 centres
- Participants
- 23,043 candidates · 111 centers
- Exposure
- Post-policy vs pre-policy
- Post-policyn = 12,021
- Pre-policyn = 11,022reference
- Outcome
- Survival benefit of transplantation (increase in average days alive after transplantation)
- Follow-up
- 3 years
Main finding
As reported in the abstract
Average 3-year survival benefit of transplantation, all statuses (per donor heart) · 3 years after transplantation
Average 3-year survival benefit across all statuses increased from pre-policy to post-policy
217.1 days to 241.2 days per donor heart (P < 0.001)
Observational data: associations, not effects.
Further findings
Absolute 3-year survival benefit, highest priority status · more than doubled
P < 0.001
Life-years saved from transplantation, first 3 years after implementation
- Additional life-years saved with the 2018 policy change
- 1,645 (4,259 vs 5,904; P < 0.001)
Long-run survival benefit, all statuses
- All statuses experienced a positive long-run survival benefit of transplantation
Original publication
Association of the 2018 U.S. Heart Allocation Policy Change and the Survival Benefit of Heart Transplantation. JACC Heart Fail. Published 4 June 2025. doi:10.1016/j.jchf.2025.02.026
Summarised from the published abstract; every number is checked against it