Racial Inequalities In The Allocation Of Left Ventricular Assist Devices: Insights From INTERMACS

Abstract

Introduction Heart Failure disproportionately affects racial and ethnic minorities. Since the development of durable continuous flow left ventricular assistive devices (LVAD) there has been growing concern that an inequitable allocation of these devices in certain patient populations occurs and must be studied in more depth. We sought to identify differences in the allocation of left ventricular assist devices (LVAD) by race. Methods We included 19,022 patients identified in INTERMACS as having a received a durable, continuous flow LVAD between March 1, 2006 and December 31, 2017 and had data on race (black, white, and other races). We tested the independent association between race and device strategy (bridge to transplant [BTT] versus destination therapy [DT]) with multivariable-adjusted logistic regression. Patients implanted according to other device strategies were excluded (N=119). Results In the study cohort, the population demographics were listed as 24.1% black, 66.8% white, and 9.2% other races. Patients listed as black race were younger with median ages of 53 (black), 61 (white), and 56 years (other race) (p-value <0.001). Black race had a higher proportion of women (31% vs 18% vs 19%), limited social support (5.7% vs 2.7% vs 3.3%), and single status (33% vs 13% vs 19%) rather than married status (46% vs 70% vs 61%) (p-value <0.001 for all). Additionally, black race was independently associated with 15% lower odds of having a LVAD as BTT instead of DT (table). Conclusion In patients with advanced heart failure who have received a durable LVAD, black race is independently associated with DT strategy as opposed to a BTT strategy after multivariable adjustment for demographic, clinical, and socioeconomic confounding. These observations highlight a disparity in the allocation of LVADs in clinical practice by race in North America and underscore the need to identify reasons for this potential inequality. Heart Failure disproportionately affects racial and ethnic minorities. Since the development of durable continuous flow left ventricular assistive devices (LVAD) there has been growing concern that an inequitable allocation of these devices in certain patient populations occurs and must be studied in more depth. We sought to identify differences in the allocation of left ventricular assist devices (LVAD) by race. We included 19,022 patients identified in INTERMACS as having a received a durable, continuous flow LVAD between March 1, 2006 and December 31, 2017 and had data on race (black, white, and other races). We tested the independent association between race and device strategy (bridge to transplant [BTT] versus destination therapy [DT]) with multivariable-adjusted logistic regression. Patients implanted according to other device strategies were excluded (N=119). In the study cohort, the population demographics were listed as 24.1% black, 66.8% white, and 9.2% other races. Patients listed as black race were younger with median ages of 53 (black), 61 (white), and 56 years (other race) (p-value <0.001). Black race had a higher proportion of women (31% vs 18% vs 19%), limited social support (5.7% vs 2.7% vs 3.3%), and single status (33% vs 13% vs 19%) rather than married status (46% vs 70% vs 61%) (p-value <0.001 for all). Additionally, black race was independently associated with 15% lower odds of having a LVAD as BTT instead of DT (table). In patients with advanced heart failure who have received a durable LVAD, black race is independently associated with DT strategy as opposed to a BTT strategy after multivariable adjustment for demographic, clinical, and socioeconomic confounding. These observations highlight a disparity in the allocation of LVADs in clinical practice by race in North America and underscore the need to identify reasons for this potential inequality.