Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Card Fail. 2021 May;27(5):597-601. doi: 10.1016/j.cardfail.2021.01.010.
This study evaluates the Area Deprivation Index (ADI) as a novel prognostic metric of socioeconomic status for patients with a left ventricular assist device.
A retrospective analysis of patients with a left ventricular assist device at a high-volume institution from 2007 to 2018 was conducted. Socioeconomic status was determined using the ADI, a multifactorial neighborhood-based metric where higher ADI denotes worse socioeconomic status. Patients were stratified into 4 ADI cohorts. Long-term survival was compared with multivariate analysis. Of the 380 patients stratified by ADI, 35 were in the 10th percentile or lower, 218 were in the 11th-50th percentile, 104 were in the 51st-89th percentile, and 23 were in the 90th percentile or higher. Baseline characteristics were comparable. On multivariate analysis, being male (hazard ratio [HR], 0.14; P = .01), bridge-to-transplant (HR, 0.14; P = .03), and not requiring biventricular support (HR, 0.02; P < .01) were protective, whereas chronic kidney disease (HR, 9.07; P < .01) and an elevated total bilirubin (HR, 3.56; P = .02) were harmful. The ADI as a continuous variable did not affect survival; however, categorically, a higher ADI was protective (ADI 90-100: HR, 0.07; P = .04).
Socioeconomically disadvantaged patients had noninferior outcomes given appropriate pre-implant optimization and workup.
本研究评估了区域剥夺指数（ADI）作为一种新的左心室辅助装置患者社会经济地位的预后指标。
对一家高容量机构 2007 年至 2018 年期间接受左心室辅助装置治疗的患者进行了回顾性分析。使用 ADI 确定社会经济地位，ADI 是一种基于多因素的基于邻里的指标，ADI 值越高表示社会经济地位越差。患者分为 4 个 ADI 队列。使用多变量分析比较长期生存情况。在根据 ADI 分层的 380 名患者中，35 名患者处于 10%或更低，218 名患者处于 11%至 50%，104 名患者处于 51%至 89%，23 名患者处于 90%或更高。基线特征具有可比性。多变量分析显示，男性（风险比[HR]，0.14；P=0.01）、桥接移植（HR，0.14；P=0.03）和不需要双心室支持（HR，0.02；P<0.01）是保护性因素，而慢性肾脏病（HR，9.07；P<0.01）和总胆红素升高（HR，3.56；P=0.02）是有害因素。ADI 作为连续变量对生存没有影响；然而，分类上，较高的 ADI 具有保护作用（ADI 90-100：HR，0.07；P=0.04）。
在适当的植入前优化和检查下，社会经济地位不利的患者具有非劣效的结局。
