Racial Disparities in Patients Bridged to Heart Transplantation With Left Ventricular Assist Devices

Lui, Cecillia; Fraser, Charles D.; Zhou, Xun; Suarez‐Pierre, Alejandro; Kilic, Ahmet; Zehr, Kenton J.; Higgins, Robert S.D.

doi:10.1016/j.athoracsur.2019.03.073

Cited by 33 publications

(21 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While AAs are known to have lower survival after orthotopic HTx, 3 BTT with an LVAD was found to result in similar outcomes. These findings are in contrast to what was described by Lui et al ., 11 who reported on 6478 patients who were BTT between 2005 and 2018. The authors found that the AA race is associated with an increased rate of post‐transplant graft failure and 5 year mortality when compared with Caucasians.…”

Section: Discussioncontrasting

confidence: 95%

Racial disparities and outcomes of left ventricular assist device implantation as a bridge to heart transplantation

et al. 2020

View full text Add to dashboard Cite

Aims This study investigated outcomes after continuous flow left ventricular assist device (CF-LVAD) implantation as bridge to heart transplantation (BTT) in advanced heart failure patients stratified by race. Methods and results De-identified data from the United Network for Organ Sharing database was obtained for all patients who had a CF-LVAD as BTT from 2008 to 2018. Patients were stratified into four groups on the basis of ethnicity [Caucasian, African American (AA), Hispanic, and others (Asian, Pacific Islanders, and American Indian)]. Outcomes investigated were waitlist mortality or delisting and post-transplant 5 year survival. Cox proportional hazards modelling was used to identify independent predictors of waitlist mortality or delisting and post-transplant survival. We used Kaplan-Meier survival curves and the log-rank test to estimate and compare survival among groups. A total of 14 234 patients who had CF-LVADs as BTT were identified. Of these, 64% (n = 9058) were Caucasians, 26% (n = 3677) were AA, 7% (n = 997) were Hispanic, and 3% (n = 502) had a different race. Compared with Caucasian, AA, and Hispanic patients had higher body mass indexes and a lower level of education and are more likely to be public health insurance beneficiaries. There was a significantly lower incidence of transplantation in AAs compared with Caucasians, Hispanics, and others at 12, 24, and 60 months, respectively (Gray's test, P < 0.001). The AA race was a significant predictor of waitlist mortality or delisting owing to worsening clinical status [hazard ratio, 95% confidence interval: 1.10 (1.01 to 1.16; P < 0.001)]. Among those who were successfully BTT, risk-adjusted posttransplant survival was similar among the four groups (log-rank test: P = 0.589). Conclusions Disparities exist among different races that receive a CF-LVAD as a BTT. These disparities translate into increased waitlist morbidity and mortality but not long-term post-transplant survival among those who successfully reach transplant.

show abstract

Section: Discussioncontrasting

confidence: 95%

Racial disparities and outcomes of left ventricular assist device implantation as a bridge to heart transplantation

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Small studies have also suggested that 30 days mortality was not significantly different among racial groups after LVAD implantation 26,27 . However, an analysis of the United Network of Organ Sharing database showed that AA patients with LVAD as a bridge to transplantation had increased rates of graft failure after transplantation and decreased 5‐year survival compared to Caucasians 28 . Consistent with previously reported analyses, our study showed no significant difference in in‐hospital postoperative complications and in‐hospital mortality after adjustment of patients and hospital‐related characteristics.…”

Section: Discussionmentioning

confidence: 99%

Racial disparities in in‐hospital outcomes after left ventricular assist device implantation

et al. 2020

View full text Add to dashboard Cite

Background Previous studies of patients undergoing various cardiac surgeries demonstrated worse outcomes among African‐American (AA) patients. It remains unclear if the race is a predictor of outcomes among left ventricular assist device (LVAD) recipients. Methods Patients who underwent LVAD implantation between 2010 and 2017 were identified using the National Inpatient Sample. The race was classified as Caucasians vs AA vs Hispanics, and endpoints were in‐hospital outcomes, length of stay, and cost. Procedure‐related complications were identified via the International Classification of Diseases‐9 (ICD‐9) and ICD‐10 coding and analysis performed via mixed‐effect models. Results A total of 27 132 adults (5114 unweighted) underwent LVAD implantation in the U.S. between 2010 and 2017, including Caucasians (63.8%), AA (23.8%), and Hispanics (6%). The number of LVAD implantations increased in both Caucasians and AA during the study period. AA LVAD recipients were younger, with higher rates of females and mostly comorbidities, but lower rates of coronary artery disease and bypass grafting compared to Caucasians and Hispanics. Medicaid and median income at the lowest quartile were more frequent among AA LVAD recipients. We did not identify differences in stroke, bleeding complications, tamponade, infectious complications, acute kidney injury requiring hemodialysis, and in‐hospital mortality among racial groups. AA LVAD recipients had lower rates of routine discharge than Caucasians and Hispanics, longer length of stay than Caucasians, but similar cost of hospitalization. After adjustment for clinical comorbidities, race was not a predictor of in‐hospital mortality. Conclusion We identified differences in clinical characteristics but not in in‐hospital complications among LVAD recipients of a different races.

show abstract

“…Financial limitations might influence the adherence to follow-up visits in the posttransplant period. In patients who were successfully bridged with an LVAD to heart transplantation, similar reports demonstrated that the African-American race is associated with the increased rates of graft failure after transplantation and decreased in 5-year survival compared with the Caucasian race ( 68 ).…”

Section: Heart Transplantationmentioning

confidence: 84%

Social Inequalities in Non-ischemic Cardiomyopathies

Amiya

2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Heart failure (HF) has various characteristics, such as etiology, clinical course, and clinical characteristics. Several studies reported the clinical findings of the characteristics of non-ischemic cardiomyopathy. There have been issues with genetic, biochemical, or pathophysiological problems. Some studies have been conducted on non-ischemic cardiomyopathy and social factors, for instance, racial disparities in peripartum cardiomyopathy (PPCM) or the social setting of hypertrophic cardiomyopathy. However, there have been insufficient materials to consider the relationship between social factors and clinical course in non-ischemic cardiomyopathies. There were various methodologies in therapeutic interventions, such as pharmacological, surgical, or rehabilitational, and educational issues. However, interventions that could be closely associated with social inequality have not been sufficiently elucidated. We will summarize the effects of social equality, which could have a large impact on the development and progression of HF in non-ischemic cardiomyopathies.

show abstract

Racial Disparities in Patients Bridged to Heart Transplantation With Left Ventricular Assist Devices

Cited by 33 publications

References 18 publications

Racial disparities and outcomes of left ventricular assist device implantation as a bridge to heart transplantation

Racial disparities and outcomes of left ventricular assist device implantation as a bridge to heart transplantation

Racial disparities in in‐hospital outcomes after left ventricular assist device implantation

Social Inequalities in Non-ischemic Cardiomyopathies

Contact Info

Product

Resources

About