Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices

Autumn M. Clemons, Raul J. Flores, Raia Blum, Brian Wayda, Danielle L. Brunjes, Marlena Habal, Raymond C. Givens, Lauren K. Truby, A. Reshad Garan, Melana Yuzefpolskaya, Koji Takeda, Hiroo Takayama, Maryjane A. Farr, Yoshifumi Naka, Paolo C. Colombo, Veli K. Topkara

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used in advanced heart failure patients. Recent studies suggest that low socioeconomic status (SES) predicts worst survival after heart transplantation. Both individuallevel and neighborhood-level SES (nSES) have been linked to cardiovascular health; however, the impact of SES in CFLVAD patients remains unknown. We hypothesized that SES is a major determinant of CF-LVAD candidacy and postimplantation outcomes. A retrospective chart review was conducted on 362 patients between February 2009 and May 2016. Neighborhood-level SES was measured using the American Community Survey data and the Agency for Healthcare Research and Quality SES index score. Individual-level SES was self reported. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression determined survival statistics. Patients in the highest SES tertile were older (58 ± 13 vs. 53 ± 14; p < 0.001), less likely to be black or Hispanic (26% vs. 70%; p < 0.001), more likely to be married (87% vs. 65%; p < 0.001), more likely to have private insurance (50% vs. 39%; p < 0.001), and more likely to have employment (29% vs. 15%; p < 0.001) compared with patients in the lowest tertile. Low nSES was associated with a decreased risk of death (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.347-0.970; p = 0.038) in comparison to the high nSES. However, after adjusting for baseline clinical morbidities, the relationship was no longer present. When selecting patients for a LVAD, SES should not be thought of as an immutable risk factor. Carefully selected low-SES patients could be safely implanted with CF-LVAD with outcomes comparable to high-SES patients.

Original languageEnglish (US)
Pages (from-to)373-380
Number of pages8
JournalASAIO Journal
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • Left ventricular assist device
  • Mortality
  • Outcomes
  • Psychosocial risk
  • Socioeconomic status

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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