Results
A total weighted estimate of 25,503 hospitalizations for LVAD
implantation were identified during 2011 to 2017. Average age of the
entire cohort was 57 ±13 years, with a median of 59 years, ranging from
18 to 90 years. Female gender accounted for 23% (n=5,820) of the total
population. The high-income group comprised 47% (n=11,907) of the
cohort and the low-income group represented 53% (n=13,595) (See Table
1). All comparisons henceforth are reported as low-income versus (vs.)
high-income for consistency. We found an average increased rate of LVAD
implantation from 2011 to 2017 of 11% for the low-income group and 8%
for higher income individuals (See Figure A).
Low-income group mean age was significantly lower (55±14 vs. 58±13,
p<0.001), with an increased proportion of females (24% vs.
22%, p<0.001) when compared to the high-income group.
Patients with higher income are more likely to be from suburbs of metro
areas of ≥ 1 million population (13% vs. 42%, p<0.001) and
self-identified as White (57% vs. 70%, p<0.001). In term of
comorbidities, the low-income group was found to have significantly
higher proportions of hypertension (41% vs. 37%, p<0.001),
smoking (28% vs. 24%, p<0.001), anemia (7% vs. 6%,
p<0.001), dyslipidemia (39% vs. 35%, p<0.001),
obesity (18% vs. 15%, p<0.001) and pulmonary hypertension
(41% vs. 36%, p<0.001). However, the high-income group had
increased rates of atrial tachyarrhythmias including atrial fibrillation
and atrial flutter (48% vs. 50%, p<0.001) and history of
coronary artery bypass graft (9% vs. 11%, p<0.001). There
were no significant differences found in diabetes, alcohol and substance
abuse, malnutrition, prior strokes, coronary artery disease, peripheral
artery disease, chronic kidney disease, chronic liver disease, history
of percutaneous coronary intervention or obstructive sleep apnea between
both groups.
However, in the high-income group, we found significantly longer
hospital stay (median 29 [20-42] vs. 29 [20-44] days,
p<0.001) (See Figure B), higher hospital charges (median
$770,852 [544,193-1,135,933] vs. $727,922 [539,402-1,034,619],
p<0.001), increased proportion of post procedure strokes
(5.6% vs. 8.3%, p<0.001) with ischemic strokes comparison of
4% vs. 7% (p<0.001), acute kidney injury (59% vs. 63%,
p<0.001), bleeding (29% vs. 33%, p<0.001) and need
of extracorporeal membrane oxygenation (6% vs. 8%, p<0.001)
(see Table 2).
No significant differences were found in the incidences of ventricular
arrhythmias, blood product transfusions, pericardial complications,
postoperative deep venous thrombosis and pulmonary embolism, LVAD
thrombosis or embolism between groups. There was a decreased rate of
in-hospital mortality in patients undergoing LVAD from 2011 to 2017 in
both groups (See Figure C).
Combining data from all years (2011–2017), high-income was associated
with higher post-LVAD all-cause inpatient mortality (odds ratio (OR)
1.303; 95%, confidence interval (CI) 1.207–1.407; p<0.001)
that remained significant beyond adjustment for demographic factors and
comorbidities (OR 1.178; 95% CI 1.085–1.280; p<0.001).