Disparities in Access to Left Ventricular Assist Device Therapy

David L. Joyce, John V. Conte, Stuart D. Russell, Lyle D. Joyce, David C. Chang

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Implantation of a left ventricular assist device (LVAD) has been shown to improve survival and quality of life among selected patients with end-stage heart failure. We hypothesized that utilization of this complex and expensive treatment modality would be influenced by disparities in access to health care. Materials and Methods: We reviewed data from the National Inpatient Sample from 2002 to 2003. Patients were included in the study if they were admitted to the hospital with a primary diagnosis of congestive heart failure or cardiogenic shock. Patients older than 85 years of age and those with contraindications to LVAD therapy due to pre-existing medical conditions were excluded from the study. A multivariate logistic regression analysis was performed to determine the influence of patient characteristics (age, gender, race, comorbidities, socioeconomic status, insurance status, and population density of residence) as well as hospital characteristics (academic versus private and geographic region) on LVAD implantation. Results: A total of 297,866 patients met the inclusion criteria for the study. Only 291 of these patients underwent LVAD implantation. Factors that adversely influenced access to therapy included age >65 (OR = 0.14), female gender (OR = 0.44), black race (OR = 0.29), admission to a non-academic center (OR = 0.16), and geographic region. Conclusions: LVAD implantation was significantly influenced by disparities in access to treatment. Systematic reform in the delivery of evolving medical technologies to patients is needed to eliminate these disparities.

Original languageEnglish (US)
Pages (from-to)111-117
Number of pages7
JournalJournal of Surgical Research
Volume152
Issue number1
DOIs
StatePublished - Mar 2009
Externally publishedYes

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Heart-Assist Devices
Therapeutics
Heart Failure
Preexisting Condition Coverage
Health Services Accessibility
Insurance Coverage
Cardiogenic Shock
Population Density
Social Class
Comorbidity
Inpatients
Logistic Models
Regression Analysis
Quality of Life
Technology
Survival

Keywords

  • disparities
  • gender
  • heart failure
  • left ventricular assist device
  • race

ASJC Scopus subject areas

  • Surgery

Cite this

Joyce, D. L., Conte, J. V., Russell, S. D., Joyce, L. D., & Chang, D. C. (2009). Disparities in Access to Left Ventricular Assist Device Therapy. Journal of Surgical Research, 152(1), 111-117. https://doi.org/10.1016/j.jss.2008.02.065

Disparities in Access to Left Ventricular Assist Device Therapy. / Joyce, David L.; Conte, John V.; Russell, Stuart D.; Joyce, Lyle D.; Chang, David C.

In: Journal of Surgical Research, Vol. 152, No. 1, 03.2009, p. 111-117.

Research output: Contribution to journalArticle

Joyce, DL, Conte, JV, Russell, SD, Joyce, LD & Chang, DC 2009, 'Disparities in Access to Left Ventricular Assist Device Therapy', Journal of Surgical Research, vol. 152, no. 1, pp. 111-117. https://doi.org/10.1016/j.jss.2008.02.065
Joyce, David L. ; Conte, John V. ; Russell, Stuart D. ; Joyce, Lyle D. ; Chang, David C. / Disparities in Access to Left Ventricular Assist Device Therapy. In: Journal of Surgical Research. 2009 ; Vol. 152, No. 1. pp. 111-117.
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