Socioeconomic status associated with the probability of receiving a heart pump

African American or Hispanic, uninsured or Medicaid-insured patients living in low-income postal codes are less likely to receive a heart pumping device called LVAD (LVAD), depending on a preliminary study presented at the 2019 Scientific Sessions of the American Heart Association on research on quality of care and outcomes, a leading global exchange on the latest advances in quality of care and research on outcomes for cardiovascular disease and stroke for researchers, health professionals and policy makers.

Research has shown that there are disparities in the socioeconomic status badociated with the types of care patients receive for heart disease and their effectiveness after treatment. The new study examined the relationship between socio-economic status and LVAD implantation, typically used to keep patients waiting for cardiac transplantation or as a final therapy for patients with heart failure. In addition, researchers sought to determine whether the expansion of Medicaid via the Affordable Care Act, intended to improve access to insurance and health care for more people, had had an impact on the implementation of LVAD.

"There is a clear disparity in terms of access to innovative therapies such as LVAD," said Wang Xiaowen, MD, a senior scientist and medical instructor at Washington University in St. Louis. "Health care providers need to be aware of this disparity when making decisions about patient care."

The researchers used the federal government's Inpatient State Database, which contains all inpatient care records from participating states. They reviewed data on all patients under the age of 85 admitted for heart failure or cardiogenic shock in Alaska, Arizona, Colorado, Florida, Iowa, Maryland, Mbadachusetts, Michigan, Nebraska, Nevada, New Jersey, New York, Vermont and Washington. and Wisconsin between January 1, 2012 and September 30, 2015.

Of the 889,377 patients, 64.6% were over 65, 43.3% were female, and 64.2% were Caucasian. In total, approximately 3,700 patients received LVAD. The researchers found that:

• African-Americans were 28% less likely and Hispanics 38% less likely to receive ASDL compared to Caucasians;
• Patients receiving Medicare were 28% less likely, those in Medicaid, 57% less and those without insurance, 90% less likely to receive LVAD compared to patients receiving private insurance; and
• Patients living in postal codes with the lowest income were 26% less likely to receive LVAD than those living in a high income area.

Among patients who received LVAD, African Americans and Hispanics were less likely to die in hospital compared to Caucasians. Private insured patients who received LVAD had death rates similar to those of Medicare, higher mortality rates than those in Medicaid patients, and lower mortality rates than uninsured patients.

The researchers also compared LVAD implantation rates in patients likely to be mediocre in states having extended the extension of Medicaid to those who did not extend the extension. of Medicaid during the 21-month study period. They found that the LVAD implantation rate in the Medicaid expansion states had increased slightly from 0.35% before to 0.40% after expansion. Outside the states of expansion, the LVAD implementation rate remained at 0.23% over the study period. The differences between these changes were not statistically significant.

Not all states participate in the inpatient database, which limits the study, especially for the badysis of LVAD implantation rates in Medicaid expands states and non-Medicaid. Another limitation was the lack of data after 2015.

"As LVADs become more and more common with technological advances that reduce complication rates and make devices more portable, health care providers will need to better understand the underlying causes of these disparities between those who benefit from these potentially vital treatments and those who do not, "Wang said.

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