Racial Disparities and Outcomes after Left Ventricular Assist Device Implantation as Bridge to Transplantation or Destination Therapy
Alexis K. Okoh1, Molly Schultheis1, Setri Fugar2, Biruk K. Almaz1, Olivia Chan1, Nikhil K. Shah1, Nicolette Stelter1, Ravindra K. Karanam1, Mark Russo1, Margarita T. Camacho1, RWJ Barnabas Health, Newark, NJ, USA1, Rush University Medical Center, Chicago, IL, USA2
OBJECTIVE: We sought to investigate outcomes after left ventricular assist device (LVAD) implantation in advanced heart failure patients stratified by race.
METHODS: Patients who had LVADs inserted at a single center as a bridge to transplant (BTT) or destination therapy (DT) were divided into 3 groups based on race. Caucasian, African American (AA), Hispanic. Post-operative outcomes including complications, discharge disposition and survival at defined time points were compared. Cox proportional hazards were used to identify factors associated with 1-year all-cause survival.
RESULTS: A total of 158 patients who had LVADs as BTT (n=63) and DT (n=95) were studied. Of these, 56% (n=89) were Caucasians, 35% (n=55) were AA and 9% (n=14) were Hispanics. AA patients had higher BMI, lower socioeconomic status and educational level and were more likely to be single or divorced. Operative outcomes were similar among all 3 groups. Unadjusted 30-day, 6-month, 1-year and 2 year survival rates for Caucasians vs. AA vs Hispanics were, 30-day (82% vs. 89% vs. 93%, p=0.339), 6-month (74% vs. 80 % vs. 71%, p=0.596), 1-year (67% vs. 76% vs. 71% p=0.511), 2-years (56% vs. 62% vs, 68%, p=0.797). On multivariate analysis, device related infection was the only factor associated with 1-year survival.
CONCLUSIONS: AA patients who undergo LVAD implantation as BTT or DT have lower socioeconomic status and educational level compared to their Caucasian or Hispanic counterparts. These differences however do not translate into post-implant survival outcomes.