Kelty C E, Dickinson M G, Fogarty K J
Interdisciplinary Health Sciences PhD Program, Western Michigan University, Kalamazoo, MI, United States of America.
The DeVos Cardiovascular Research Program, Spectrum Health, Grand Rapids, MI, United States of America.
Am Heart J Plus. 2022 Jul 5;17:100172. doi: 10.1016/j.ahjo.2022.100172. eCollection 2022 May.
This study aims to better understand how demographic, psychosocial, and socioeconomic factors influence the selection of patients for advanced therapies for heart failure (heart transplant and left ventricular assist device (LVAD)).
Patients evaluated for heart transplant or LVAD at a large, Midwestern hospital system were assessed retrospectively. Three outcomes were analyzed: 1) Patients who were evaluated and approved to receive a transplant or LVAD were compared to patients who were not approved for transplant or LVAD; 2) Patients who were listed for transplant were compared to patients not listed; and 3) Patients who received a transplant or LVAD were compared to patients who did not receive a transplant or LVAD. ANOVA was used for continuous variables and Chi-squared test for categorical variables. Significant variables were further analyzed by logistic regression.
Four hundred fifty-nine patients were included. Marital status (p = 0.004), race (p = 0.008), social support (p < 0.001), mental health (p = 0.006), and substance use (p < 0.001) were associated with whether patients were approved for transplant or LVAD. Patients with public insurance were half as likely (OR 0.495) to be listed for transplant once approved.
Financial, psychosocial, and demographic characteristics all play a role in selection for advanced therapies for heart failure. These insights can help guide future work on interventions to address the social disparities in access to heart transplant and LVAD.
本研究旨在更好地了解人口统计学、心理社会和社会经济因素如何影响心力衰竭患者接受高级治疗（心脏移植和左心室辅助装置（LVAD））的选择。
对一家大型中西部医院系统中接受心脏移植或LVAD评估的患者进行回顾性评估。分析了三个结果：1）将接受评估并被批准接受移植或LVAD的患者与未被批准接受移植或LVAD的患者进行比较；2）将列入移植名单的患者与未列入名单的患者进行比较；3）将接受移植或LVAD的患者与未接受移植或LVAD的患者进行比较。连续变量采用方差分析，分类变量采用卡方检验。对显著变量进一步进行逻辑回归分析。
纳入459例患者。婚姻状况（p = 0.004）、种族（p = 0.008）、社会支持（p < 0.001）、心理健康（p = 0.006）和物质使用（p < 0.001）与患者是否被批准接受移植或LVAD有关。一旦获得批准，拥有公共保险的患者被列入移植名单的可能性只有一半（OR 0.495）。
财务、心理社会和人口统计学特征在心力衰竭高级治疗的选择中均起作用。这些见解有助于指导未来关于干预措施的工作，以解决心脏移植和LVAD获取方面的社会差异。
