Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
J Card Fail. 2021 Apr;27(4):497-500. doi: 10.1016/j.cardfail.2020.12.009. Epub 2020 Dec 18.
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.
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.
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.
左心室辅助装置(LVAD)是一种可供选择的治疗方案,适用于患有晚期心力衰竭的患者。然而,健康的社会决定因素在很大程度上影响着患者接受设备植入后的结果。
我们利用 DECIDE-LVAD 试验,评估了健康的社会决定因素(婚姻状况、家庭收入、种族/民族、教育程度和医疗保险)在评估时的状况,并评估了它们与随后一年内 LVAD 植入率的关系。大约四分之一的患者未婚(即单身/离婚/丧偶/分居;n=55[26%])。同样比例的患者家庭收入低于每年 20,000 美元(n=50[24%])。少数患者为其他种族(n=39[18%]),受教育程度低于高中学历(n=14[6.6%]),或主要由医疗补助计划支付(n=17[8.4%])。与已婚或有伴侣的患者相比,未婚患者接受 LVAD 植入的比例明显较低。LVAD 植入与收入、种族、教育程度或保险状况无关。
我们从美国私人和学术医院的多个 LVAD 中心的数据中发现,在接受 LVAD 评估的广泛患者样本中,已婚或有伴侣的状态与 LVAD 植入呈正相关,但其他健康的社会决定因素则不然。未来的研究和政策变化应考虑为缺乏社会支持的患者改善 LVAD 植入机会的新干预措施。