CARC18: Towards Equitable Care: Exploring The Association Between Geographic Household Median Income And Clinical Outcomes Following Left Ventricular Assist Device Implantation

Abstract

Purpose: Socioeconomic status (SES) is hypothesized to be an important predictor of clinical outcomes following left ventricular assist device (LVAD) implantation due to high costs of care. We investigated whether median income of a patient’s residing neighborhood predicts mortality or rate of readmission in LVAD therapy. Methods: 210 patients implanted with an LVAD between January 2010 and April 2020 at a single tertiary care center in the United States were retrospectively enrolled in this study. Patients were classified into tertiles based on published neighborhood median income data and compared for survival and freedom from readmission. Results: The study cohort comprised 135 unique ZIP codes, with 34 (25.2%) above and 101 (74.8%) below the national median income level. The low, middle, and high income groups had a total survivorship of 92.8%, 95.5%, and 92.5% at 1 year and 85.5%, 89.4%, and 85.1% at 3 years, respectively. Low median income was not significantly associated with worse outcomes at 1-year (P=0.400) and 3-years (P=0.689) following LVAD implantation. There was similarly no significant difference in freedom from readmissions at 3 years. Conclusion: LVAD recipients with a lower geographic median income were not more likely to experience worse outcomes after LVAD implantation. These findings were contrary to prior published reports showing worse clinical outcomes in heart transplant patients with lower SES patients. Factors such as institution-specific and system-wide patient assistance programs and risk factor modification measures may have mitigated the impact of reduced SES on patient care and helped eliminate the effect of income disparity on long-term clinical outcome post LVAD implantation. Further research to study such potential association is warranted.