Temporal Trends in Contemporary Use of Ventricular Assist Devices by Race and Ethnicity

Breathett, Khadijah; Allen, Larry A.; Helmkamp, Laura; Colborn, Kathryn; Daugherty, Stacie L.; Blair, Irene V.; Jones, Jacqueline; Khazanie, Prateeti; Mazimba, Sula; McEwen, Marylyn Morris; Stone, Jeff; Calhoun, Elizabeth A.; Sweitzer, Nancy K.; Peterson, Pamela N.

doi:10.1161/circheartfailure.118.005008

Cited by 66 publications

(62 citation statements)

References 16 publications

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“…Although the percentage of blacks amongst people undergoing LVAD implantation is much less than whites, the rate of LVAD utilization in blacks is more than whites, hispanics, and other races. This observation is similar to findings by previous studies which showed increased LVAD implantation rates among blacks in comparison to other race/ethnicities [18,19]. The reason may be due to insurance coverage increases amongst blacks in recent years [20].…”

Section: Discussionsupporting

confidence: 91%

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: 91%

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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“…2,8 Although women have a higher prevalence of heart failure than men, 3 women receive less than one-quarter of heart transplants and VADs. 2,8 This may be related to a higher prevalence of heart failure with preserved ejection fraction in women than in men, 3 which is rarely an indication for transplantation and not an indication for VADs. However, more than 40% of heart failure hospitalizations in white women are attributed to heart failure with reduced ejection fraction, 3,9 and African American women have higher rates of heart failure with reduced ejection fraction than preserved ejection fraction.…”

Section: Introductionmentioning

confidence: 99%

Association of Gender and Race With Allocation of Advanced Heart Failure Therapies

et al. 2020

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IMPORTANCE Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and racial biases are associated with the allocation of advanced therapies among women. OBJECTIVE To determine whether the intersection of patient gender and race is associated with the decision-making of clinicians during the allocation of advanced heart failure therapies. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, 46 US clinicians attending a conference for an international heart transplant organization in April 2019 were interviewed on the allocation of advanced heart failure therapies. Participants were randomized to examine clinical vignettes that varied 1:1 by patient race (African American to white) and 20:3 by gender (women to men) to purposefully target vignettes of women patients to compare with a prior study of vignettes of men patients. Participants were interviewed about their decision-making process using the think-aloud technique and provided supplemental surveys. Interviews were analyzed using grounded theory methodology, and surveys were analyzed with Wilcoxon tests. EXPOSURE Randomization to clinical vignettes. MAIN OUTCOMES AND MEASURES Thematic differences in allocation of advanced therapies by patient race and gender. RESULTS Among 46 participants (24 [52%] women, 20 [43%] racial minority), participants were randomized to the vignette of a white woman (20 participants [43%]), an African American woman (20 participants [43%]), a white man (3 participants [7%]), and an African American man (3 participants [7%]). Allocation differences centered on 5 themes. First, clinicians critiqued the appearance of the women more harshly than the men as part of their overall impressions. Second, the African American man was perceived as experiencing more severe illness than individuals from other racial and gender groups. Third, there was more concern regarding appropriateness of prior care of the African American woman compared with the white woman. Fourth, there were greater concerns about adequacy of social support for the women than for the men. Children were perceived as liabilities for women, particularly the African American woman. Family dynamics and finances were perceived to be greater concerns for the African American woman than for individuals in the other vignettes; spouses were deemed inadequate support for women. Last, participants recommended ventricular assist devices over transplantation for all racial and gender groups. Surveys revealed no statistically significant differences in allocation recommendations for African American and white women patients. (continued) Key Points Question Is bias against a patient's gender and race associated with the allocation of advanced heart failure therapies? Findings In a qualitative study of 46 health care professionals, there was more bias against women compared with men when evaluating appearance and social support, particularly among African American women. Fina...

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“…3 Collective efforts by practitioners aimed at studying and minimizing the adverse outcomes of minorities post-transplant have resulted in an upsurge in the number of non-Caucasians receiving LVADs as a BTT. 4 Additionally, the nationwide attempt at universal medical insurance through the Affordable Care Act has resulted in more treatment options for minorities with heart failure ranging from increase in number of mechanical circulatory support (MCS) devices implanted to a surge in the prevalence of minorities receiving an HTx. 5,6 For chronic conditions such as heart failure, the long-term costs are expensive and thus warrant careful evaluation of available therapies and their impact on outcomes in order to mitigate any potential racial disparities that may exist.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Temporal Trends in Contemporary Use of Ventricular Assist Devices by Race and Ethnicity

Cited by 66 publications

References 16 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

Association of Gender and Race With Allocation of Advanced Heart Failure Therapies

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

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