The impact of socioeconomic status in patients with left ventricular assist devices (LVADs)

Abstract

Background: Socioeconomic status (SES) can be a powerful predictor of adverse outcomes among heart failure patients but its impact on survival and readmission following left ventricular assist device (LVAD) implantation surgery is poorly understood. We investigated if the LVAD recipients from more deprived neighborhoods experienced higher mortality and readmission rate after device implantation as compared to those from less deprived areas.Methods: This is a single center, retrospective analysis evaluating adults who received Heartmate III and Heartware HVAD implants between 2009 and 2018. SES indicators were area of deprivation index (ADI), race and income. Our cohort was grouped by ADI quartiles from least deprived (Q1), Q2, Q3 to the most deprived (Q4). Outcomes included overall mortality and readmission following surgery.Results: A total of 191 patients were included in the study. Demographics by SES indicators demonstrated that least deprived (Q1) patients were older than the most deprived (65 vs. 57, p < .01), African-American patients originated from more deprived neighborhoods than Caucasians (ADI 87 vs. 62, p < .001), and high-income patients had higher preoperative BUN and creatinine. Outcome differences included a decreased risk of death in most deprived patients (Q4) compared to the least deprived (Q1), however after adjusting for age, LVAD indication, and INTERMACS profile this was no longer significant. No differences in survival or readmission by race or income was observed Conclusion: SES does not independently impact survival and readmission after Heartware HVAD and Heartmate III LVAD implantation. More studies are needed to evaluate if other SES factors affect these outcomes.

Long-Term Medical Treatment and Adherence in Patients With Left Ventricular Assist Devices: A Danish Nationwide Cohort Study

“…In previous studies regarding socioeconomic status and clinical outcomes among patients with LVADs, socioeconomic status did not affect mortality, [33][34][35][36] nor survival or delisting on the heart transplant waiting list. 37 Conflicting results have been reported regarding hospital readmission, [33][34][35]38 The literature suggests that the careful selection of LVAD candidates, pre-LVAD optimization regarding patients' medical, behavioral, and psychosocial needs, and effective LVAD management program may mitigate poor clinical outcomes among those with low socioeconomic status. 33,35,36 Moreover, follow-up care that is organized and structured with frequent visits and time to address worries about medications and improve self-efficacy may improve medication adherence.…”

“…37 Conflicting results have been reported regarding hospital readmission, [33][34][35]38 The literature suggests that the careful selection of LVAD candidates, pre-LVAD optimization regarding patients' medical, behavioral, and psychosocial needs, and effective LVAD management program may mitigate poor clinical outcomes among those with low socioeconomic status. 33,35,36 Moreover, follow-up care that is organized and structured with frequent visits and time to address worries about medications and improve self-efficacy may improve medication adherence. 39 This may also explain why we did not observe a difference in medication use and adherence.…”

Socioeconomic status and in‐hospital outcomes for patients undergoing heart transplantation or ventricular assist device implantation

“…Among patients bridged to HT with a durable LVAD between 2004 and 2014, SES was not associated with waitlist outcomes although post-transplant outcomes were worse in the lowest SES quartile compared to the remaining quartiles.6 Regarding LVAD outcomes, single centers studies demonstrated that SES had limited to non-significant effects on post LVAD outcomes. [7][8][9] We expand on these findings from a larger national cohort to further highlight lack of association between SES and in-hospital outcomes during index LVAD and HT hospitalizations in the current era.…”

Social Inequalities in Non-ischemic Cardiomyopathies

“…Another study showed that low SES might not affect the clinical course after LVAD implantation (60). The readmission ratio was also not changed by the low SES (61). SES does not independently impact the survival and readmission after HeartWare HVAD and Heartmate III LVAD implantation.…”