Abstract 14303: Disparities in Mechanical Circulatory Support Utilization in Patients With End Stage Heart Failure

Abstract

Despite optimum guideline directed medical therapy, one-year mortality rate of patients with end stage heart failure exceeds 50%. The use of mechanical circulatory support (MCS) has been shown to improve the overall quality of life in patients with advance stage heart failure. Studies have explored disparities in clinical outcome of patients undergoing mechanical circulatory support for acute myocardial infarction and cardiogenic shock. Data on sex-specific, racial, and socioeconomic disparities in patients with end stage heart failure requiring MCS as a bridge-to-transplant or destination therapy is limited. Using the most recent National Inpatient Sample database, we hypothesized that disparities found among other patient populations also exist in patients with end stage heart failure needing MCS. In our study, 1.5% of patients with end stage heart failure underwent MCS with a mean age of 55±16 yrs. Females accounted for 20.7% (20.69% vs 79.3%, p =0.002). Patients who received MCS had lower comorbities; Diabetes (38.8% vs 43.5%, p =0.308), COPD (8.6% vs 24.9%, p <0.001), CKD (47.4% vs 63.1%, p =0.001), and Hyperlipidemia (43.1% vs 47.5%, p =0.347). Among patients with end stage heart failure, mean charlson index by race were 4.4 vs 4.6 vs 4.5 for Whites, Blacks, and Hispanics respectively, p =0.008. After controlling for age, comorbities, charlson index, insurance types, household income and place of residence, compared to Whites, Blacks and Hispanic with end stage heart failure were significantly less likely to undergo MCS (Blacks: aOR=0.50, 95% CI: 0.29-0.87, p =0.014) (Hispanics: aOR=0.68, 95% CI: 1.48, p =0.337). Females compared to males also had lower odds of receiving MCS in end stage heart failure (aOR=0.56, 95% CI: 0.34-0.92, p =0.021). We observed patients with end stage heart failure who received MCS were younger and had less comorbidities. After controlling for age, comorbidities and potential confounders, the odds of females and minority patients with end stage heart failure receiving MCS was about half. These findings underscore the importance of addressing social determinants of health in minority populations. Further implementation studies are required to help bridge the health equity gap in patients with end stage heart failure.