Disparities in Ambulatory HF Ventricular Assist Device Implantation

Jun 30, 2023
Font Size
A
A
A
Authors:
Dixon DD, Knapp SM, Ilonze O, et al.
Citation:
Racial and Ethnic Disparities in Ambulatory Heart Failure Ventricular Assist Device Implantation and Survival. JACC Heart Fail 2023;Jun 28:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • VAD implantation rates in Black and White patients with ambulatory HF were similar but higher than rates in Hispanic patients.
  • Since the incidence and prevalence of HF is higher in Black and Hispanic individuals compared to White individuals, the similar rates of VAD implantation in Black and White patients and reduced rates in Hispanic patients represent lower than expected VAD implantation rates in minorities and a racial and ethnic disparity.
  • Additional studies are indicated to assess the individual, institutional, and structural factors influencing VAD implantation rates.

Study Questions:

What are the racial and ethnic differences in ventricular assist device (VAD) implantation rates and post-VAD survival among patients with ambulatory heart failure (HF)?

Methods:

The investigators, using the INTERMACS (Interagency Registry of Mechanically Assisted Circulatory Support) database (2012-2017), examined census-adjusted VAD implantation rates by race, ethnicity, and sex in patients with ambulatory HF (INTERMACS profile 4-7) using negative binomial models with quadratic effect of time. Survival was evaluated using Kaplan-Meier estimates and Cox models adjusted for clinically relevant variables and an interaction of time with race/ethnicity.

Results:

VADs were implanted in 2,256 patients with ambulatory HF (78.3% White, 16.4% Black, and 5.3% Hispanic adults, respectively). Median age at implantation was lowest in Black patients. Implantation rates peaked between 2013-2015 before declining in all demographic groups. From 2012-2017, implantation rates overlapped for Black and White patients but were lower for Hispanic patients. Post-VAD survival was significantly different among the three groups (log rank p value = 0.0067), with higher estimated survival among Black vs. White patients (12-month survival: Black patients 90% [95% CI, 86-93%]; White patients 82% [95% CI, 80-84%]). Low sample size for Hispanic patients resulted in imprecise survival estimates (12-month survival: 85% [95% CI, 76-90%]).

Conclusions:

The authors report that Black and White patients with ambulatory HF had similar VAD implantation rates but rates were lower for Hispanic patients.

Perspective:

This study reports that VAD implantation rates in Black and White patients with ambulatory HF were similar, but higher than rates in Hispanic patients. Of note, the incidence and prevalence of HF is generally higher in Black and Hispanic individuals compared to White individuals. The similar rates of VAD implantation between Black and White patients and reduced rates in Hispanic patients therefore represent lower than expected VAD implantation rates for the burden of disease in Black and Hispanic patients and suggests a larger racial and ethnic disparity in the population with ambulatory HF. Additional studies are indicated to assess the individual, institutional, and structural factors influencing VAD implantation rates.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support

Keywords: African Americans, Cardiac Surgical Procedures, Ethnic Groups, Heart-Assist Devices, Heart Failure, Hispanic Americans, Race Factors, Secondary Prevention, Survival


< Back to Listings