Division of Medicine, Forrest General Hospital, Hattiesburg, Mississippi, USA.
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Clin Transplant. 2023 Nov;37(11):e15093. doi: 10.1111/ctr.15093. Epub 2023 Aug 7.
Although lower socioeconomic status (SES) has been associated with worse in-hospital outcomes among patients with heart failure, the in-hospital outcomes for patients undergoing durable Left Ventricular Assist Device (LVAD) implantation or Heart Transplantation (HT) based on SES have not been well characterized.
We analyzed data from the National Inpatient Sample of hospitalizations between January 2016 and December 2020 of patients aged 18 and over who underwent a HT or newly implanted LVAD. Quartile classification of the median household income of the patient's residential zip code was used to estimate SES. Multivariable analyses with logistic and linear regression were used to evaluate the effects of SES on inpatient outcomes including inpatient mortality, length of stay, and key inpatient complications.
A total of 16,265 weighted hospitalizations for new LVAD implantation and 14,320 weighted hospitalizations for HT were identified. In multivariable analysis, among patients undergoing HT or LVAD implantation respectively, there were no significant differences between the lowest and highest SES quartiles among important in-hospital outcomes including length of stay (adj B-coeff .56, (-3.59)-(4.71), p = .79 and adj B-coeff 2.40, (-.21)-(5.02), p = .07) and mortality (aOR 1.02, .61-1.70, p = .94 and aOR 1.08, .72-1.62, p = .73). There were also no differences based on SES quartile in important inpatient complications including stroke and cardiac arrest.
In this analysis from the National Inpatient Sample, we demonstrate that SES, evaluated by median zip code income, was not associated with important in-hospital metrics including mortality and length of stay among patients undergoing LVAD or HT.
尽管较低的社会经济地位（SES）与心力衰竭患者的住院预后较差相关，但基于 SES 的患者接受耐用性左心室辅助装置（LVAD）植入或心脏移植（HT）的住院预后尚未得到很好的描述。
我们分析了 2016 年 1 月至 2020 年 12 月期间年龄在 18 岁及以上的接受 HT 或新植入 LVAD 的患者的国家住院患者样本数据。使用患者居住邮政编码中位数家庭收入的四分位分类来估计 SES。使用逻辑和线性回归的多变量分析来评估 SES 对住院结果的影响，包括住院死亡率、住院时间和主要住院并发症。
共确定了 16265 例新 LVAD 植入的加权住院和 14320 例 HT 的加权住院。在多变量分析中，在接受 HT 或 LVAD 植入的患者中，重要的住院结果（包括住院时间[调整 B 系数.56，（-3.59）-（4.71），p=0.79]和死亡率[aOR 1.02，（0.61）-（1.70），p=0.94]）和死亡率（aOR 1.08，（0.72）-（1.62），p=0.73））的最低和最高 SES 四分位之间没有显著差异。根据 SES 四分位数，重要的住院并发症（包括中风和心脏骤停）也没有差异。
在这项来自国家住院患者样本的分析中，我们表明 SES，通过中位数邮政编码收入评估，与接受 LVAD 或 HT 的患者的重要住院指标（包括死亡率和住院时间）无关。
