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Journal of the American Geriatrics Society Research Summary

A new study published in the Journal of the American Geriatrics Society suggests that survival rates after heart transplant surgery are similar in adults ages 18 to 69 and adults ages 70 and older.

Researchers examined a large U.S. database of patients who were listed as candidates for surgery to replace their failing hearts with healthier donor hearts. The researchers found that:

• Only 1 in 50 people who are considered for heart transplant surgery and 1 in 50 people who receive a heart transplant are ages 70 or older.
• For older adults in the study, the likelihood of surviving one or five years after a heart transplant was about the same as for younger adults.
• Having a stroke after heart transplant surgery was more common in older adults, but the risk in both age groups was low.
• Older patients were more likely to receive hearts from higher-risk donors, who are older and more likely to have diabetes and high blood pressure.
• Advanced age alone should not prevent people from being considered as candidates for heart transplants.

Why We May Need Heart Transplants as We Age

Heart failure develops when your heart can no longer pump enough blood to provide your body with the oxygen and nutrients it needs. It is usually caused by other chronic conditions that become more common as we age and is the leading cause of hospitalizations in people over 65. When heart failure can no longer be treated with medication or medical devices, a heart transplant may be necessary.

Because the supply of donor hearts is limited, healthcare professionals must make decisions about who they think has the most potential for a good recovery and long-term survival. [1] Until recently, many believed that people aged 70 or older were only good candidates for the operation if they: (a) were strong enough; (b) were able to take all the medications needed to prevent their bodies from rejecting their new heart; (c) had strong support from family and friends; (d) did not drink alcohol or smoke; and (e) did not have other serious chronic diseases or infections.

That opinion is changing as the population of older adults increases in the U.S. and a growing number of older patients receive heart transplants with positive results.  Because of improvements in patient screening and care after surgery, heart transplant surgery has become an option for people with heart failure who are expected to live five years or less.

What the Researchers Learned

Researchers at the Hartford Hospital in Connecticut included 57,285 adult patients (aged 18 and older) listed as candidates for heart transplant surgery in the U.S. between January 2000 and August 2018 in their study. They found that only one in 50 of these patients was 70 years old or older. Of the 37,135 patients who had heart surgery over the 18-year period, about the same proportion was at least 70 years old, but the number of older patients receiving a heart transplant each year has increased from 30 in 2000 to 132 in 2017.

The researchers looked at the difference between the percentage of patients ages 18-69 and patients aged 70 or older who died (the mortality rate) within one year and five years after heart transplant surgery. There was no significant difference between groups for the mortality rate in the first year after surgery, even though the older patients were more likely to receive hearts from older donors with chronic diseases like diabetes and blood pressure. The difference between the mortality rate for the older and younger patients within five years of heart transplant surgery disappeared when researchers took into consideration factors like patients’ body mass index (BMI) and the time patients spent on the transplant waitlist.

Having a stroke after heart transplant surgery was more common for older patients, but the risk was still very low (3.5 percent). In older patients, most strokes occurred during year three of the follow-up period.

Study Limitations

This study’s researchers looked at information collected in the past and observed the differences between the older and younger groups. This means they were unable to identify specific causes for their findings. What’s more, the number of older patients was very small, making it hard to draw definite conclusions from. Finally, most of the older patients who received heart transplants were white, not frail, and did not have other chronic diseases besides heart failure. The researchers noted that this group of older heart transplant recipients does not represent most older adults who have heart failure.

What This Study Means for You

If you’re 70 or older and have heart failure, heart transplant surgery might be a life-extending option for you. Consider asking your heart failure doctor whether you could be a candidate for a heart transplant.

This summary is from “Clinical Outcomes of Older Adults Listed for Heart Transplantation in The United States.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Abhishek Jaiswal, MD; Naga Vaishnavi Gadel, MBBS; David Baran, MD; Kathir Balakumaran, MD; Andrew Scatola, MD; Joseph Radojevi, MD; Jason Gluck, MD; Sabeena Arora, MD; Jonathan Hammond, MD; Ayyaz Ali, MD; Douglas L. Jennings, PharmD; and William L. Baker, PharmD.

 [1] https://www.mayoclinic.org/tests-procedures/heart-transplant/about/pac-20384750