No abstract

No abstract

Integrated PC intervention was feasible for both BTT and DT patients. Such an intervention may increase family awareness of the patient's unique concerns and may have an impact on decision making at the end of life.

Background Low socioeconomic status (SES) is a known risk factor for heart failure, mortality among those with heart failure, and poor post heart transplant (HT) outcomes. This study sought to determine if SES is associated with decreased waitlist survival while on LVAD support and after HT. Methods and Results 3,361 adult patients bridged to primary HT with an LVAD between May 2004 and April 2014 were identified in the UNOS database. SES was measured using the AHRQ SES index using data from the 2014 American Community Survey. In the study cohort, SES did not have an association with the combined endpoint of death or delisting on LVAD support (p=0.30). In a cause-specific unadjusted model, those in the top (HR 1.55, 95% CI 1.14–2.11, p=0.005) and second greatest SES quartile (HR 1.50, 95% CI 1.10–2.04, p=0.01) had an increased risk of death on device support compared to the lowest SES quartile. Adjusting for clinical risk factors mitigated the increased risk. There was no association between SES and complications. Post-HT survival, both crude and adjusted, was decreased for patients in the lowest quartile of SES index compared to all other SES quartiles. Conclusions Freedom from waitlist death or delisting was not impacted by SES. Patients with a higher SES had an increased unadjusted risk of waitlist mortality during LVAD support, which was mitigated by adjusting for increased comorbid conditions. Low SES was associated with worse post-HT outcomes. Further study is needed to confirm and understand a differential effect of SES on post-transplant outcomes that was not seen during LVAD support prior to HT.