Sociodemographic differences in utilization and outcomes for temporary cardiovascular mechanical support in the setting of cardiogenic shock

Thangam, Manoj; Luke, Alina A.; Johnson, Daniel Y.; Amin, Amit P.; Lasala, John M.; Huang, Kristine; Maddox, Karen E. Joynt

doi:10.1016/j.ahj.2020.12.014

Cited by 19 publications

(14 citation statements)

References 52 publications

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“…Of 148 studies, 26 (18%) suggested mechanistic drivers for SDoH leading to disparities in ECMO utilization and outcomes according to race/ethnicity/SES/payor factors (Data Supplement, http://links.lww.com/CCM/H327). Eleven (7%) explicitly described discrimination, implicit bias, or racism as contributors (26–28, 30, 80, 84, 93, 161, 167–169). Explanations by study authors were grouped into individual-level, hospital-level, and systemic/structural factors (21).…”

Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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Objectives: To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. Data Sources: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). Study Selection: Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. Data Extraction: Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data Synthesis: Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. Conclusions: Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.

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Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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“…Current trends show a decrease in intra-aortic balloon pump use and increases in micro-axial LVADs and extracorporeal membrane oxygenation use in both sexes ( 48 ). Despite being sicker at presentation ( 44 ), TMCS is underutilized in women ( 49 ) and is associated with greater complication rates, including vascular complications that sometimes require surgical interventions ( 50 ). Women experience greater mortality from cardiogenic shock than men despite TMCS use ( 49 ).…”

Section: Life Sustaining Therapies For Women With Advanced Heart Failurementioning

confidence: 99%

“…Despite being sicker at presentation ( 44 ), TMCS is underutilized in women ( 49 ) and is associated with greater complication rates, including vascular complications that sometimes require surgical interventions ( 50 ). Women experience greater mortality from cardiogenic shock than men despite TMCS use ( 49 ). In acute myocardial infarction related-cardiogenic shock, women received TMCS support less frequently ( 48 ) even though Impella support prior to percutaneous coronary intervention is associated with greater survival benefits in women than men ( 44 ).…”

Section: Life Sustaining Therapies For Women With Advanced Heart Failurementioning

confidence: 99%

Special Considerations in the Care of Women With Advanced Heart Failure

Ebong

DeFilippis

Hamad

et al. 2022

Front. Cardiovasc. Med.

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Advanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.

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“…There is a paucity of data to help assess potential sex differences in decision making at the clinician or system level. It is known that females are less likely to receive temporary mechanical circulatory support in the setting of cardiogenic shock (OR = 0.76); this is also true of black patients and those insured by Medicare and Medicaid ( 10 ). An additional challenge in understanding durable device delivery is the interplay of decision making with that of heart transplantation.…”

Section: Pre-implant Considerations: From Diagnosis To Device Deliverymentioning

confidence: 99%

Sex-based considerations for implementation of ventricular assist device therapy

Jones‐Ungerleider

Rose²,

Knott³

et al. 2022

Front. Cardiovasc. Med.

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Women with advanced heart failure receive advanced surgical therapies such as durable left ventricular assist device (LVAD) implantation or heart transplantation at a rate much lower compared to males. Reasons for this discrepancy remain largely unknown. Much of what is understood reflects outcomes of those patients who ultimately receive device implant or heart transplantation. Females have been shown to have a higher mortality following LVAD implantation and experience higher rates of bleeding and clotting phenomena and right ventricular failure. Beyond outcomes, the literature is limited in the identification of pre-operative factors that drive lower than expected LVAD implant rates in this population. More focused research is needed to define the disparities in advance heart failure therapy delivery in women and other underserved populations.

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Sociodemographic differences in utilization and outcomes for temporary cardiovascular mechanical support in the setting of cardiogenic shock

Cited by 19 publications

References 52 publications

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Special Considerations in the Care of Women With Advanced Heart Failure

Sex-based considerations for implementation of ventricular assist device therapy

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