A study of nearly 900,000 patients with heart failure or cardiogenic shock revealed their race, insurance coverage and ZIP code were associated with their odds of receiving a left ventricular assist device (LVAD).
The preliminary research was presented April 6 at the American Heart Association’s Quality of Care and Outcomes Research (QCOR) scientific sessions in Arlington, Virginia.
“There is a clear disparity in terms of access to advanced therapies like LVAD,” Xiaowen Wang, MD, lead author and instructor in medicine at Washington University in St. Louis, said in a press release. “Healthcare providers need to be mindful of this disparity as they make decisions about patient care.”
Wang and colleagues used the State Inpatient Database to look at inpatient care records from 15 states between January 2012 and September 2015. They identified 889,377 patients who were less than 85 years old and were admitted for heart failure or cardiogenic shock in those states.
Of these patients, about 3,700 received LVADs. However, the following factors were linked to the likelihood of an individual receiving a heart pump, which can be offered either as a bridge to heart transplantation or a destination therapy:
- Blacks were 28% less likely and Hispanics were 38% less likely to receive an LVAD compared to whites.
- Compared to patients with private insurance, those with Medicare coverage (28% less likely), Medicaid coverage (57%) and no insurance (90%) were all less likely to get an LVAD.
- Patients living in the lowest-income ZIP codes were 26% less likely to be implanted with an LVAD versus those in the highest-income ZIP codes.
“As LVADs become more common with technological advances that lower complication rates and make the devices more portable, healthcare providers will need to better understand the underlying causes of these disparities in who gets these potentially lifesaving therapies and who doesn’t,” Wang said.
The researchers also evaluated whether Medicaid expansion played a role in LVAD implantation rates. However, they didn’t detect a statistically significant change after the policies went into effect in expansion versus non-expansion states.
Limitations of the study include the lack of data from after 2015 and from states that don’t participate in the State Inpatient Database.