Utilization of Left Ventricular Assist Devices in Vulnerable Adults Across Medicaid Expansion

Influence of Social Determinants of Health on Heart Failure Outcomes: A Systematic Review

“…Black race (compared with White race), 30 , 48 older age (compared with younger age), 48 female sex (compared with male sex), 61 and being uninsured (compared with public or private insurance) 48 were associated with decreased probability of device implantation or transplantation. In 6 studies, race and ethnicity, 29 , 31 , 70 age, 61 education, 13 , 30 , 31 income, 13 , 31 insurance status, 13 , 30 , 31 , 61 urban/rural residence, 13 and neighborhood‐level SES 30 were not significantly associated with medical device implantation or transplantation.…”

“…In total, 59 articles met the criteria for inclusion (Table S2 ). 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , …”

“…Some studies also examined complications related to these procedures, such as device‐related infection, gastrointestinal bleeding, device thrombosis, stroke, or any cause rehospitalization. In these studies, younger age (compared with older age), 70 male sex (compared with female sex), 30 , 48 , 70 and state Medicaid expansion (compared with nonexpansion) 29 were associated with increased probability of device implantation or transplantation. Black race (compared with White race), 30 , 48 older age (compared with younger age), 48 female sex (compared with male sex), 61 and being uninsured (compared with public or private insurance) 48 were associated with decreased probability of device implantation or transplantation.…”

Relation of Left Ventricular Assist Device Infections With Cardiac Transplant Outcomes

“…Allograft rejection was defined as antibody-mediated rejection (pathologic antibody-mediated rejection ≥1), acute cellular rejection ≥2R as seen on endomyocardial biopsy specimen, or hemodynamic compromise with graft failure. 5,6 ARF was classified as (1) a threefold increase in creatinine from patient's baseline, (2) an increase in creatinine to ≥5.0 mg/100 ml for ≥48 hours after HT, or (3) new requirement for initiation of renal replacement therapy (continuous venovenous hemofiltration or hemodialysis) during index hospitalization. 7 Transplant rejection and mortality were assessed until 1 year after HT.…”

“…Left ventricular assist devices (LVADs) are frequently implanted as a bridge to transplantation for patients with end-stage heart failure awaiting heart transplant (HT). 1,2 From 2010 to 2018, approximately 43% of the nearly 37,000 worldwide HT recipients had a durable LVAD in place at the time of transplantation. 3 Although LVAD therapy has afforded improved quality of life and survival for patients on the waiting list, they are still limited by adverse events, the most common of which are LVAD-specific infections (LSIs).…”