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Le parcours de soin des greffés cardiaques en France : détermination des facteurs associés à leur accès à la greffe

Abstract : Heart transplantation (HTx) is the preferred option for medically refractory advanced heart failure. Due to the small number of available grafts, current allocation policy in France, as in many other countries, is based on the severity of the candidate’s heart disease. This Ph. D thesis was designed to determine candidate and center factors associated with access to heart transplantation in France and in-hospital care pathways one year before heart transplantation using appropriate methodologies and the national hospital database. We first analyzed 1-year mortality in patients listed for HTx in France from 2010 to 2013 using competing risk models in order to distinguish patient-related predictors and the influence of allocation policy. We then distinguished the proportions explained by candidate characteristics and center factors with the persistent between-center variability on 1-year access to transplantation (2010-2014). These disparities are mediated by the severity of the candidate’s heart disease, the allocation system and listing practices rather than by transplant activity. These findings provide a new contribution to improve the heart transplant allocation scoring system in France. The study based on the nationwide administrative database overcomes a major limitation of the national transplantation registry by shedding light on the healthcare pathway of heart transplanted recipients (2010-2015) during the year prior to transplantation. These findings will be useful to assess the medical benefits and criteria for registration on the heart transplant waiting list. This study will be continued by a detailed analysis of the healthcare consumption of these patients based on French national health insurance (SNDS) data.
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Submitted on : Monday, April 9, 2018 - 4:15:08 PM
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Christelle Cantrelle. Le parcours de soin des greffés cardiaques en France : détermination des facteurs associés à leur accès à la greffe. Santé publique et épidémiologie. Université Paris-Saclay, 2018. Français. ⟨NNT : 2018SACLS063⟩. ⟨tel-01762119⟩

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