[Regional differences in referral for heart transplantation].

UNLABELLED: Although cardiac transplantation is a well established means of treating end-stage heart disease, only selected patients receive this therapy. The aim of this study was, therefore, to investigate the frequency of referrals for and performed cardiac transplantations and to assess the prognosis of patients from the different regions of German-speaking Switzerland. From the beginning of 1989 to October 1995, 401 patients, aged 49 +/- 12 years, were referred to the University Hospital of Zurich for evaluation of the possibility of cardiac transplantation. 149 (37%) of them were transplanted. Transplanted patients had greater cardiac impairment than those who were not transplanted. There was no differences in age or underlying diseases. More patients from the south-eastern part of Switzerland were referred than from the north-eastern part. In contrast to this, the frequency of transplanted patients was similar to all parts of Switzerland. Survival rate was not related to the origin of transplanted patients (1-year survival 80%, 5-year survival 73%) whereas overall survival in patients who were not transplanted was significantly worse (1-year survival 64%, 5-year survival 45%) and differed between the various parts of our catchment area. Patients from regions with a high referral rate had better survival. Patients who lived in or near big cities were less frequently referred and had worse survival. Also, survival was related to the number of follow-up controls in the specialized clinic for heart failure and heart transplantation. In 1989 and 1994, years in which more than 30 patients were transplanted at our institute, only 4 of 69 (5.8%) died while waiting for transplantation, whereas during the other years 25 of 132 (18.9%) died (odds ratio = 0.26; p = 0.01). Moreover, the time from listing to transplantation was significantly shorter in 1989 and 1994 (50 +/- 66 vs. 95 +/- 134 days, p = 0.001).

CONCLUSIONS: Patients from the different parts of our catchment area were not equally referred for heart transplantation. The better survival of non-transplanted patients from regions with a high referral rate suggests that the possibility of transplantation is taken into account earlier and more frequently. Follow-up controls of these patients in a specialized centre seem to be useful since these patients have a better outcome. Nevertheless, the recruitment of donors remains the unsolved problem.