Heart failure & cardiomyopathies
The Accuracy of Initial U.S. Heart Transplant Candidate Rankings
Authors' conclusion
The treatment-based 6-status heart allocation system has only moderate ability to rank-order candidates by medical urgency.
Study context
- Population
- US heart transplant candidates listed postpolicy (November 2018 to March 2020), Scientific Registry of Transplant Recipients
- Exposure
- 6-status ranking vs novel prediction models
- Outcome
- Death before receipt of a heart transplant
Methodological detailsregistry-based, prognostic model development and validation
- Registry-based
- Prognostic model development and validation
Main finding
As reported in the abstract
Ability to rank-order candidates by urgency (C-index)
| Group | C-index |
|---|---|
| 6-status ranking | 0.67 |
| Cox proportional hazards model | 0.76 |
| Random survival forest model | 0.74 |
C-index
6-status ranking0.67
Cox proportional hazards model0.76
Random survival forest model0.74
- Statuses 4 and 6: no significant difference in survival
- P = 0.80
- Status 5 lower survival than status 4
- P < 0.001
Observational data: associations, not effects.
Further findings
Survival by status
- Statuses 4 and 6: no significant difference in survival
- P = 0.80
- Status 5 lower survival than status 4
- P < 0.001
Variable importance
- Objective physiologic measurements (e.g. glomerular filtration rate) had high variable importance
Original publication
The Accuracy of Initial U.S. Heart Transplant Candidate Rankings. JACC Heart Fail. Published 12 April 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →