Impact of Race and Ethnicity on Readmissions After HeartMate 3 (HM3) Implantation

Abstract

<h3>Purpose</h3> Black pts and pts of Hispanic origin are underrepresented in most left ventricular assist devices (LVAD) trials leading to a limited understanding of outcomes in these populations. In this study, we compared survival and rates of readmission among Black, Hispanic and White pts who received a HM3 at a single large volume center. <h3>Methods</h3> We retrospectively reviewed all pts who underwent HM3 implant from 11/14 to 12/19. All unplanned readmissions up to 900-days of follow-up were analyzed. Readmissions were categorized into: major bleeding, infection, arrhythmia, volume overload, device related complications and other causes. Survival was evaluated by KM method. Incidence of all-cause readmission was evaluated using mean cumulative function method. <h3>Results</h3> Of 182 HM3 pts, 37(20.3%) were self-identified as Black, 27(14.2%) as Hispanic and 109(59.9%) as White. White pts were older 64.2(58.9,70.5)yo than Black 55.8(51,61.3)yo and Hispanic 52.5(41.2,61.9)yo (p<0.0001). White pts were more likely to be male (90.8%) compared to Black (55.8%) and Hispanic (52.5%) (p=0.003). Preimplant creatinine was higher in Black 1.5(1.2,1.8) than Hispanic 1.2(0.9,1.5) and White 1.4(1.1, 1.7) mg/dl (p=0.03). Postimplant length-of-stay during index admission was 28(22,37)d in Black, 21(17,33)d in Hispanic and 30(20,47)d in White (p=0.03). 900-day survival was 86.5% in Black 96.3% in Hispanic and 79.9% in White (p=0.15) (<b>Figure 1A</b>). Cumulative incidence of readmissions was similar among groups. However, Black had more arrhythmia and Hispanics more infection as cause for readmission compared to the other groups (<b>Figure 1B</b>). <h3>Conclusion</h3> Our data did not show a survival difference among Black, Hispanic and White HM3 pts. Although cumulative incidence of all-cause readmissions was similar, arrhythmia was more common in Blacks and infection in Hispanics. Further work is needed to better understand factors that may affect access to LVAD therapy and to investigate differences in adverse event profiles among races and ethnic groups.