Contemporary Trends in Disparities of LVAD Use in HFrEF, with José López, MD

Research presented at the Heart Failure Society of America (HFSA) 2023 Annual Scientific Meeting is providing new insight into trends of racial disparities in left ventricular assist devices (LVADs) for underserved populations with heart failure.

Presented by José López, MD, a cardiology fellow at the University of Miami JFK Medical Center, results of the study suggest Black race was associated with increased LVAD utilization relative to their non-Hispanic White counterparts, but Lopez cautioned this may not be a positive finding, with results suggesting White patients were more likely to receive transplants than their Black or Hispanic counterparts.¹

“We are putting LVADs in patients, maybe with the intent of doing a bridge to transplant later on, but we are just leaving these patients with LVADs,” explained López, in an interview with HCPLive Cardiology at HFSA 2023. “This happens more to patients of lower socioeconomic status and those with Black or Hispanic race and ethnicity.”

Citing previous research into racial disparities in heart failure management,² Lopez and a team of colleagues launched the current study with the intent of exploring contemporary trends in LVAD utilization. To do so, investigators designed the current research endeavor as a multicenter, national, retrospective cohort study using data recorded within from the National Inpatient Sample from 2016-2019 for adult patients with heart failure with reduced ejection fraction (HFrEF).¹

Using data from the 7,674,108 HFrEF-related hospital admissions during the study period, investigators planned to stratify the sample in Black, Hispanic, and White cohorts to determine the rate of LVAD utilization per 100,000 admissions, which was assessed using multivariate regression analysis. Among the 7.6 million HFrEF-related hospitalizations, 0.2% (n=14,665) underwent LVAD placement.¹

A baseline comparison of the stratified cohorts revealed Black patients were more likely to be of lower socioeconomic status and be rolled in Medicaid than their Hispanic and White counterparts. Upon analysis, results of the study suggested the rate of LVAD utilization was greater among black patients compared to White and Hispanic patients (P <.001). Investigators pointed out, although this indicates there may no longer be a disparity in access to LVADs for Black patients, results suggest a displacement towards LVAD therapy while systematically preferring heart transplantation for White patients.¹

As part of our on-site coverage of HFSA 2023, the editorial team of HCPLive Cardiology sat down with López to learn more about this study, the results, and how he interprets the findings. That interview is the subject of the following video.

Lopez has no disclosures to report.

References:

1. Lopez J, Duarte G, Mark J, et al., Racial And Ethnic Disparities In The Contemporary Utilization Of Left Ventricular Assist Devices In The United States. Paper presented at: Heart Failure Society of America 2023 Annual Scientific Meeting; October 6 - 9; Cleveland, OH. Accessed October 7, 2023.
2. Morris A, Shah KS, Enciso JS, et al. The Impact of Health Care Disparities on Patients With Heart Failure. J Card Fail. 2022;28(7):1169-1184. doi:10.1016/j.cardfail.2022.04.008