Brief Report
Social Determinants of Health and Rates of Implantation for Patients Considering Destination Therapy Left Ventricular Assist Device

https://doi.org/10.1016/j.cardfail.2020.12.009Get rights and content

Background

A left ventricular assist device (LVAD) is a treatment option available to select patients with advanced heart failure. However, there are important social determinants of health that can play a role in determining patients’ outcomes after device placement.

Methods and Results

We leveraged the DECIDE-LVAD Trial to assess social determinants of health—relationship status, household income, race/ethnicity, educational attainment, and health insurance—at the time of evaluation, and their association with rate of LVAD placement in the subsequent year. About a quarter of patients were unpartnered (i.e., single/divorced/widowed/separated; n = 55 [26%]). A similar proportion had a household income of less than $20,000 per year (n = 50 [24%]). Few patients were other race (n = 39 [18%]), had less than a high school education (n = 14 [6.6%]), or had Medicaid as their primary payor (n = 17 [8.4%]). LVAD implantation was significantly lower among patients who were unpartnered compared with patients who were married or partnered. LVAD implantation was not associated with income, race, educational attainment or insurance status.

Conclusions

Our data from diverse LVAD centers at U.S. private and academic hospitals found that, among a broad sample of patients being evaluated for LVAD, married or partnered status was favorably associated with LVAD implantation, but other social determinants of health were not. Future research and policy changes should consider novel interventions for improving access to LVAD implantation for patients with inadequate social support.

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Acknowledgments

Disclosure: K. Flint, None; E. L. Chaussee, None; K. Henderson, None; K. Breathett, None; P. Khazanie, None; J. S. Thompson, None; C. K. McIlvennan, None; S. J. LaRue, None; D. D. Matlock, None; L. A. Allen, None

Funding

Funded through Patient-Centered Outcomes Research Institute (PCORI) Awards (CDR-1310-06998 and SDM-2017C2-8640). The views, statements, opinions in this work are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. This work was also supported in part by the National Heart, Lung and Blood Institute (1K23HL105896-01, Allen), the Heart Failure Society of

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