Impact of insurance type on eligibility for advanced heart failure therapies and survival

Hutcheson, Sarah; Phillips, Victoria; Patzer, Rachel E.; Smith, Andrew L.; Vega, J. David; Morris, Alanna A.

doi:10.1111/ctr.13328

Cited by 16 publications

(8 citation statements)

References 32 publications

(56 reference statements)

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“…Private insurance may play a significant role, with the rate of LVAD utilization being highest amongst patients holding private insurance based on our results. Patients with medicaid were less likely to get LVAD according to our study and this finding is similar to previous studies [21,22].…”

Section: Discussionsupporting

confidence: 92%

Utilization of Left Ventricular Assist Device for Congestive Heart Failure: Inputs on Demographic and Hospital Characterization From Nationwide Inpatient Sample

Modi¹,

Pannu²,

Shah³

et al. 2021

Cureus

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The first goal of the study is to provide a descriptive overview of the utilization of left ventricular assist device (LVAD) for the treatment of congestive heart failure (CHF) and determine the rates of LVAD use stratified by patients' demographic and hospitals' characteristics in the United States. Next, is to measure the hospitalization outcomes of length of stay (LOS) and cost in inpatients managed with LVAD. MethodsWe conducted a cross-sectional study using the nationwide inpatient sample and included 184,115 patients (age ≥65 years) with a primary discharge diagnosis of hypertensive and non-hypertensive CHF and was further classified by inpatients who were managed with LVAD. We compared the distributions of demographic and hospital characteristics in CHF inpatients with versus without LVAD by performing Pearson's chi-square test for categorical variables, and independent sample t-test for continuous variables.

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Section: Discussionsupporting

confidence: 92%

Utilization of Left Ventricular Assist Device for Congestive Heart Failure: Inputs on Demographic and Hospital Characterization From Nationwide Inpatient Sample

Modi¹,

Pannu²,

Shah³

et al. 2021

Cureus

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“…Similarly, advanced heart failure patients with Medicaid are also less likely to receive left ventricular support devices and Medicaid is a signi cant predictor of higher one-year mortality in this group [13]. Our study also echoes well-known insurance disparities in cancer treatment.…”

Section: Discussionsupporting

confidence: 75%

Insurance Disparity in Cardiovascular Mortality among Non-Elderly Cancer Survivors

Shi

Jiang

Zhu

et al. 2021

Preprint

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Background:Insurance status plays a vital role in cancer diagnosis, treatments and survival. Cancer patients have higher cardiovascular disease (CVD) mortality than the general population. Methods: The Surveillance, Epidemiology and End Results (SEER) program 2007-2016 was used to estimate the CVD mortality among cancer patients aged 18 to 64 years at the time of diagnosis of an initial malignancy with the eight most prevalent cancers. Standardized mortality ratios (SMRs) were calculated for each insurance (Private vs Medicaid vs Uninsured) using coded cause of death from CVD with adjustment of age, race, and gender. The Fine-Grey Model was used to estimate adjusted Hazard Ratios (HR) of each insurance in CVD mortality. Results: A total of 768,055 patients were included in the final analysis. CVD death in patients with Medicaid insurance remained higher than in those with private insurance (HR=1.71; 95%CI, 1.61-1.81; p<0.001). Older age, male gender, and black race were all associated with increased CVD mortality in the multivariable model. Compared to the general population, patients with Medicaid had the highest SMRs of CVD mortality, regardless of year of cancer diagnosis, follow-up time, cancer site, and race. Private insured patients had similar CVD mortality to the general population after 2 years out from their cancer diagnosis. Conclusion: Cancer patients with private insurance have significantly lower CVD mortality than those with no insurance or Medicaid. The insurance disparity remained significant regardless of type of CVD, cancer site, year of diagnosis and follow-up time.

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“…Patient adherence and social history both were found to weigh heavily on clinician decision-making [ 41 , 42 ]. Medicare and Medicaid insurance predicted lower odds of both left ventricular assist device (LVAD) and eligibility for heart transplant [ 43 ]. However, Medicaid expansion resulted in a 30% increase in the rate of heart transplant listings for Black patients in early adopter states [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

A scoping review of inequities in access to organ transplant in the United States

Park

Jones

Kaplan

et al. 2022

Int J Equity Health

107

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Background Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. Patients face unique barriers to referral and acceptance for organ transplant based on social determinants of health, and patients from disenfranchised groups suffer from disproportionately lower rates of transplantation. Our objective was to review the literature describing disparities in access to organ transplantation based on social determinants of health to integrate the existing knowledge and guide future research. Methods We conducted a scoping review of the literature reporting disparities in access to heart, lung, liver, pancreas and kidney transplantation based on social determinants of health (race, income, education, geography, insurance status, health literacy and engagement). Included studies were categorized based on steps along the transplant care continuum: referral for transplant, transplant evaluation and selection, living donor identification/evaluation, and waitlist outcomes. Results Our search generated 16,643 studies, of which 227 were included in our final review. Of these, 34 focused on disparities in referral for transplantation among patients with chronic organ disease, 82 on transplant selection processes, 50 on living donors, and 61 on waitlist management. In total, 15 studies involved the thoracic organs (heart, lung), 209 involved the abdominal organs (kidney, liver, pancreas), and three involved multiple organs. Racial and ethnic minorities, women, and patients in lower socioeconomic status groups were less likely to be referred, evaluated, and added to the waiting list for organ transplant. The quality of the data describing these disparities across the transplant literature was variable and overwhelmingly focused on kidney transplant. Conclusions This review contextualizes the quality of the data, identifies seminal work by organ, and reports gaps in the literature where future research on disparities in organ transplantation should focus. Future work should investigate the association of social determinants of health with access to the organ transplant waiting list, with a focus on prospective analyses that assess interventions to improve health equity.

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Impact of insurance type on eligibility for advanced heart failure therapies and survival

Abstract: Despite younger age and fewer comorbidities, patients with Medicaid insurance are less likely to receive DT LVAD and have an increased risk of death once deemed ineligible for HT. Medicaid patients in Georgia need improved access to DT LVAD.

Cited by 16 publications

References 32 publications

Utilization of Left Ventricular Assist Device for Congestive Heart Failure: Inputs on Demographic and Hospital Characterization From Nationwide Inpatient Sample

Utilization of Left Ventricular Assist Device for Congestive Heart Failure: Inputs on Demographic and Hospital Characterization From Nationwide Inpatient Sample

Insurance Disparity in Cardiovascular Mortality among Non-Elderly Cancer Survivors

A scoping review of inequities in access to organ transplant in the United States

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