Recipients of Public Insurance Have Increased Mortality Post-LVAD

Abstract

LVADs have revolutionized the care of end-stage heart failure patients. Utilizing block-group census data to characterize neighborhood-level socioeconomic status(nSES), we set out to examine the effect of nSES & public versus private insurance status with respect to overall mortality and readmission. We performed a retrospective review of LVAD recipients bet. Jun 2006 & Dec 2016 at the Ohio State University Wexner Medical Center (n=239). Primary outcomes were time to death and time to readmission. Patients' demographics are shown in Table 1. Patients on public insurance displayed a higher hazard of death post-LVAD compared to private insureds (Fig. 1; log-rank p=0.0004). Medicaid, Medicare, and Medicaid-Medicare dual-enrollment were significant independent predictors of death, with an associated ≥3 fold hazard of death. TR of varying severity was also a significant independent predictor of mortality (Table 2). Median household income (MHI) was not associated with any primary outcomes. LVAD recipients on public insurance were at higher mortality risk compared to private insureds. Block-group level MHI failed to predict mortality and 1 year readmission for these patients. More work is needed to properly contextualize the SES impact on LVAD outcomes.