TY - JOUR
T1 - Social Determinants of Health and Rates of Implantation for Patients Considering Destination Therapy Left Ventricular Assist Device
AU - Flint, Kelsey
AU - Chaussee, Erin L.
AU - Henderson, Kamal
AU - Breathett, Khadijah
AU - Khazanie, Prateeti
AU - Thompson, Jocelyn S.
AU - Mcilvennan, Colleen K.
AU - Larue, Shane J.
AU - Matlock, Daniel D.
AU - Allen, Larry A.
N1 - Funding Information:
Funded through Patient-Centered Outcomes Research Institute (PCORI) Awards (CDR-1310-06998 and SDM-2017C2-8640). The views, statements, opinions in this work are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. This work was also supported in part by the National Heart, Lung and Blood Institute (1K23HL105896-01, Allen), the Heart Failure Society of America (McIlvennan), the National Institute on Aging (1K23AG040696, Matlock), REDCap database hosting through University of Colorado supported by NIH/NCRR Colorado CTSI (Grant Number UL1 TR001082). Dr. Breathett has research funding from National Heart, Lung, and Blood Institute (NHLBI) K01HL142848, R25HL126146 subaward 11692sc, and L30HL148881; University of Arizona Health Sciences, Strategic Priorities Faculty Initiative Grant; and University of Arizona, Sarver Heart Center, Novel Research Project Award in the Area of Cardiovascular Disease and Medicine, Anthony and Mary Zoia Research Award. Dr. Khazanie has institutional research grant support from National Institutes of Health (K23 HL145122). All other authors have no disclosures or sources of funding to report.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/4
Y1 - 2021/4
N2 - Background: A left ventricular assist device (LVAD) is a treatment option available to select patients with advanced heart failure. However, there are important social determinants of health that can play a role in determining patients’ outcomes after device placement. Methods and Results: We leveraged the DECIDE-LVAD Trial to assess social determinants of health—relationship status, household income, race/ethnicity, educational attainment, and health insurance—at the time of evaluation, and their association with rate of LVAD placement in the subsequent year. About a quarter of patients were unpartnered (i.e., single/divorced/widowed/separated; n = 55 [26%]). A similar proportion had a household income of less than $20,000 per year (n = 50 [24%]). Few patients were other race (n = 39 [18%]), had less than a high school education (n = 14 [6.6%]), or had Medicaid as their primary payor (n = 17 [8.4%]). LVAD implantation was significantly lower among patients who were unpartnered compared with patients who were married or partnered. LVAD implantation was not associated with income, race, educational attainment or insurance status. Conclusions: Our data from diverse LVAD centers at U.S. private and academic hospitals found that, among a broad sample of patients being evaluated for LVAD, married or partnered status was favorably associated with LVAD implantation, but other social determinants of health were not. Future research and policy changes should consider novel interventions for improving access to LVAD implantation for patients with inadequate social support.
AB - Background: A left ventricular assist device (LVAD) is a treatment option available to select patients with advanced heart failure. However, there are important social determinants of health that can play a role in determining patients’ outcomes after device placement. Methods and Results: We leveraged the DECIDE-LVAD Trial to assess social determinants of health—relationship status, household income, race/ethnicity, educational attainment, and health insurance—at the time of evaluation, and their association with rate of LVAD placement in the subsequent year. About a quarter of patients were unpartnered (i.e., single/divorced/widowed/separated; n = 55 [26%]). A similar proportion had a household income of less than $20,000 per year (n = 50 [24%]). Few patients were other race (n = 39 [18%]), had less than a high school education (n = 14 [6.6%]), or had Medicaid as their primary payor (n = 17 [8.4%]). LVAD implantation was significantly lower among patients who were unpartnered compared with patients who were married or partnered. LVAD implantation was not associated with income, race, educational attainment or insurance status. Conclusions: Our data from diverse LVAD centers at U.S. private and academic hospitals found that, among a broad sample of patients being evaluated for LVAD, married or partnered status was favorably associated with LVAD implantation, but other social determinants of health were not. Future research and policy changes should consider novel interventions for improving access to LVAD implantation for patients with inadequate social support.
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U2 - 10.1016/j.cardfail.2020.12.009
DO - 10.1016/j.cardfail.2020.12.009
M3 - Article
C2 - 33346077
AN - SCOPUS:85099616937
VL - 27
SP - 497
EP - 500
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
SN - 1071-9164
IS - 4
ER -