The impact of race on utilization of durable left ventricular assist device therapy in patients with advanced heart failure

Abstract

Background Heart failure affects >6 million people in the United States alone and is most prevalent in Black patients who suffer the highest mortality risk. Yet prior studies have suggested that Black patients are less likely to receive advanced heart failure therapy. We hypothesized that Black patients would have decreased rates of durable left ventricular assist device (LVAD) implantation within our expansive heart failure program. Methods A retrospective single‐center cohort study was conducted at a single high‐volume academic medical center. Patients between 18 and 85 years admitted with a diagnosis of cardiogenic shock or congestive heart failure between 1, 2013 and 12, 2017 with a left ventricular ejection fraction < 30% and inotropic dependence or need for mechanical circulatory support were included. Patients with contraindications to durable LVAD were excluded. An adjusted logistic regression model for durable LVAD implantation within 90 days of the index admission was used to determine the effect of race on durable LVAD implantation. Results Among the 702 study patients (60.9% White, 34.1% Black), durable LVAD implantation was performed within 90 days of the index admission in 183 (26%) of the cohort. After multivariate analysis, Black patients were not found to have a statistically significant difference in durable LVAD implantation rates compared to White patients in our study (OR: 0.68 [95% confidence interval: 0.45–1.04; p: .074]). Conclusions Black patients in our study did not have a statistically significant difference in the rate of durable LVAD implantation compared with White patients after adjustments were made for age, sex, socioeconomic, and clinical covariates. Larger prospective studies are needed to validate these findings.

Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction

“…Our estimates of lower rates among Black and Hispanic adults are consistent with the growing evidence of inequities in use of advanced heart failure therapies on the basis of clinical experience. 9 , 10 , 11 , 17 , 39 , 40 , 46 These estimates are in contrast with higher rates among Black adults reported by prior studies based on census population as the denominator. Nevertheless, studies using more detailed heart failure phenotype data are needed to examine the precision and robustness of our estimates of LVAD and HT rates by race and ethnicity.…”

“…In the study by Herr et al, 9 among the patients referred for evaluation, White patients were more likely to be offered LVAD and HT compared with non‐White patients. Among 702 patients with advanced heart failure in a single high‐volume center, Jones et al 10 found similar rates of LVAD receipt among White and Black patients. Prior studies of LVAD rates using large‐population–based data were based on the overall census population as the denominator.…”

“… 5 , 6 , 7 , 8 Evidence on LVAD use by sex, race, and ethnicity using convenience samples from a few health systems has been mixed. 9 , 10 , 11 Studies that compared population‐level rates of LVAD use by sex, race, and ethnicity have relied on the overall census population as the denominator. 5 , 6 However, this is a significant limitation due to well‐documented sex, racial, and ethnic differences in the prevalence of HFrEF.…”