Socioeconomic Status and LVADs, Is There an Income Disparity?

Abstract

an abnormal DSE can reliably predict the development of CAV or risk of death on follow up. Hypothesis: We hypothesize that among patients with cardiac transplantation, abnormal DSEs are not predictive of CAV or survival upon follow up. Methods: We retrospectively examined all patients who received a heart transplant at our institution between 2004-2013 (n = 192) if they had at least one DSE (6, 18 or 30 months posttransplant) followed by a coronary angiogram (annually) and excluded those with no DSEs (n = 62) or no follow up angiograms (n = 50). Baseline characteristics were examined at the time of transplant and DSE results were categorized as normal or abnormal (if they were suggestive of coronary disease). Cox regression models were used to examine the disease-free survival according to DSE result and adjusted for age, sex and subsequent DSE test results (time-dependent covariate). Results: A total of 80 patients were included with mean age 54 ± 27 (23% women). Upon follow up, mean 77 ± 31 months, 26 patients developed CAV and 10 patients died. A total of 187 DSEs were performed; 85% of these studies achieved adequate level of stress (>85% of agepredicted heart rate). Only 7 patients had abnormal DSE results. Of those who had an abnormal DSE test, none died and 4 developed CAV. Of the other 22 patients who developed CAV, 4 died. These 22 patients had a total of 50 DSE studies, 90% of which were adequate. Average left ventricular ejection fraction (EF) over the study period as determined by transthoracic echocardiogram did not differ significantly in patients who developed CAV compared to those who did not develop CAV on follow up (63.4 ± 5.5 vs 62.9 ± 6.0; P > .05). Overall, DSE tests had a sensitivity of 12.5% and a specificity of 93.8% for detection of CAV. An abnormal DSE test neither predicted the development of CAV (hazard ratio [HR] 1.38 with 95% confidence interval [CI] 0.52, 3.68) nor death (HR 1.70, 95% CI 0.34, 8.48). Conclusions: Abnormal DSE tests have a low sensitivity for diagnosis of CAV and do not predict the risk of CAV or death upon follow up. As such, we question the appropriateness of DSEs to be used as a screening test to detect CAV in cardiac transplant recipients.

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

“…Historically, minorities were found to be more likely to be affected by limited preventative care, lack of counseling about therapeutic options, and experience delays in transplantation referrals when indicated. 2,3,9,10 With targeted and concentrated efforts, disparities in the use of and access to advanced therapies such as mechanical circulatory support have been noted to be improving or alleviated. [6][7][8] However, although several studies have examined outcomes after LVAD implantation and observed no significant survival difference based on race, 4,5,9,11 rigorous evaluation of racial disparities in patients successfully bridged to transplantation with an LVAD continues to be lacking.…”