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Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices.

Publication ,  Journal Article
Clemons, AM; Flores, RJ; Blum, R; Wayda, B; Brunjes, DL; Habal, M; Givens, RC; Truby, LK; Garan, AR; Yuzefpolskaya, M; Takeda, K; Takayama, H ...
Published in: ASAIO J
April 2020

Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used in advanced heart failure patients. Recent studies suggest that low socioeconomic status (SES) predicts worst survival after heart transplantation. Both individual-level and neighborhood-level SES (nSES) have been linked to cardiovascular health; however, the impact of SES in CF-LVAD patients remains unknown. We hypothesized that SES is a major determinant of CF-LVAD candidacy and postimplantation outcomes. A retrospective chart review was conducted on 362 patients between February 2009 and May 2016. Neighborhood-level SES was measured using the American Community Survey data and the Agency for Healthcare Research and Quality SES index score. Individual-level SES was self reported. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression determined survival statistics. Patients in the highest SES tertile were older (58 ± 13 vs. 53 ± 14; p < 0.001), less likely to be black or Hispanic (26% vs. 70%; p < 0.001), more likely to be married (87% vs. 65%; p < 0.001), more likely to have private insurance (50% vs. 39%; p < 0.001), and more likely to have employment (29% vs. 15%; p < 0.001) compared with patients in the lowest tertile. Low nSES was associated with a decreased risk of death (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.347-0.970; p = 0.038) in comparison to the high nSES. However, after adjusting for baseline clinical morbidities, the relationship was no longer present. When selecting patients for a LVAD, SES should not be thought of as an immutable risk factor. Carefully selected low-SES patients could be safely implanted with CF-LVAD with outcomes comparable to high-SES patients.

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Published In

ASAIO J

DOI

EISSN

1538-943X

Publication Date

April 2020

Volume

66

Issue

4

Start / End Page

373 / 380

Location

United States

Related Subject Headings

  • Social Class
  • Retrospective Studies
  • Patient Selection
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Heart Transplantation
  • Heart Failure
  • Biomedical Engineering
 

Citation

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Chicago
ICMJE
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Clemons, A. M., Flores, R. J., Blum, R., Wayda, B., Brunjes, D. L., Habal, M., … Topkara, V. K. (2020). Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices. ASAIO J, 66(4), 373–380. https://doi.org/10.1097/MAT.0000000000001009
Clemons, Autumn M., Raul J. Flores, Raia Blum, Brian Wayda, Danielle L. Brunjes, Marlena Habal, Raymond C. Givens, et al. “Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices.ASAIO J 66, no. 4 (April 2020): 373–80. https://doi.org/10.1097/MAT.0000000000001009.
Clemons AM, Flores RJ, Blum R, Wayda B, Brunjes DL, Habal M, et al. Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices. ASAIO J. 2020 Apr;66(4):373–80.
Clemons, Autumn M., et al. “Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices.ASAIO J, vol. 66, no. 4, Apr. 2020, pp. 373–80. Pubmed, doi:10.1097/MAT.0000000000001009.
Clemons AM, Flores RJ, Blum R, Wayda B, Brunjes DL, Habal M, Givens RC, Truby LK, Garan AR, Yuzefpolskaya M, Takeda K, Takayama H, Farr MA, Naka Y, Colombo PC, Topkara VK. Effect of Socioeconomic Status on Patients Supported with Contemporary Left Ventricular Assist Devices. ASAIO J. 2020 Apr;66(4):373–380.

Published In

ASAIO J

DOI

EISSN

1538-943X

Publication Date

April 2020

Volume

66

Issue

4

Start / End Page

373 / 380

Location

United States

Related Subject Headings

  • Social Class
  • Retrospective Studies
  • Patient Selection
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Heart Transplantation
  • Heart Failure
  • Biomedical Engineering