Geographic variation in the access to heart transplantation in the Czech Republic

BackgroundHeart transplantation (HTx) is the last resort therapeutic option in management of end-stage heart failure (HF). Geographic variation in incidence of HTx may disclose regional bias in the access to health care. The purpose of the study was to evaluate regional distribution of HTx in the Czech Republic.MethodsWe retrospectively analyzed data from all patients who underwent HTx in the Czech Republic between 1.1.2008 and 30.9.2013 and determined the incidence of HTx in all counties (“okresy”) and higher administrative regions (“kraje”). In addition, we determined whether such regional incidence of HTx was related to geographical, demographic, socioeconomic factors or regional variation in coronary artery disease (CAD) or diabetes mellitus (DM) prevalence.ResultsWithin the period above, 496 HTx were performed in the only two national transplant centers (8.211 per year and million inhabitants). Their regional incidence ranged between 4.4 and 12.2 per year and million inhabitants without a significant difference.On the level of counties, difference in HTx incidence was statistically significant (p < 0.0001) with six counties out of seventy-seven being responsible for uneven distribution. The incidence of HTx was not related to the distance to the nearest HTx center (p = 0.09 for counties, p = 0.28 for regions) and was similar in regions with and without a complex cardiovascular center (7.77 ± 2.17 vs. 7.94 ± 1.56, p = 0.87 per year and million inhabitants). Interestingly, the incidence of HTx was unrelated to the number of hospitalizations for CAD in regions (p = 0.78), number of patients with DM in regions (p = 0.10), percentage of males both in regions (p = 0.32) and counties (p = 0.76) and age of population (p = 0.79 for regions, p = 0.42 for counties). HTx incidence also did not correlate with average salary in regions (p = 0.30) and unemployment rate both in counties (p = 0.76) and regions (p = 0.89).ConclusionRegional incidence of HTx was found evenly spread throughout regions, indicating no geographic restrictions in access to this advanced therapy in the Czech Republic. The variation in regional HTx incidence was unrelated to average regional age, gender, incidence of CAD or DM, income or unemployment rate.