The Impact of Socioeconomic Status on Outcomes Following Left Ventricular Assist Device Implantation at a Single Center

Abstract

Pre-operative assessment for LVAD patients often considers strong social support, counseling, and health literacy. Here, we examine how socioeconomic status (SES) plays a role in LVAD use and outcomes at a single institution. Patients were identified using the institution's medical records. The Distressed Communities Index (DCI) Score was utilized to assess for SES. The DCI incorporates education, poverty, unemployment, income, undomiciled status, and changes in employment or establishment. The score was used as both a continuous variable (from 0.0 to 100.0) and a categorical variable based on SES quintiles: Prosperous, Comfortable, Mid-Tier, At-Risk, and Distressed. Pre- and post-implantation characteristics and outcomes were analyzed. There were 426 patients who received a durable LVAD during 2012-2019. Patients were identified by DCI quintile: Prosperous (n=132), Comfortable (n=101), Mid-Tier (n=87), At-Risk (n=73), and Distressed (n=33), (p<0.001). The median DCI score for the cohort was 34.5 (Comfortable Quintile). The median age of the cohort was 60 (IQR 49-67) and was significantly different between groups. More men received durable LVAD (81.5%) and were more likely to have a higher SES. White race was associated with prosperous SES and black race with distressed SES. Higher rates of smoking and prior coronary artery bypass existed among higher SES groups (p<0.01 and 0.01, respectively). Univariable binary logistic and Poisson regression revealed that DCI score did not have a significant association with rates of orthotopic heart transplantation (OR, 1.0; 95% CI, 0.99-1.01), one-year mortality (OR 0.99; 95% CI, 0.99-1.01), or number of readmissions (Coeff., 0.002; 95% CI, -0.001-0.005, p=0.19). Patients with higher SES were more likely to receive an LVAD as treatment for refractory heart failure. Differences in socioeconomic status did not have an association with post-implantation outcomes.