Study Finds Socioeconomic Status Influences Access to Implantable Hemodynamic Monitors

Patients with chronic heart failure residing in areas with lower levels of household income were less likely to receive an implantable hemodynamic monitor, according to a new study.

Presented at the Heart Failure Society of America (HFSA) 2023 Annual Scientific Meeting, the study, which was an analysis of data from the National Inpatient Sample (NIS) recorded between 2016 and 2019, results of the study suggest in the upper percentiles of socioeconomic status were nearly 3 times more likely to receive an implantable hemodynamic monitor.

“If we know they work, I think the main premise is that people who are at the highest risk of readmission are those of lower socioeconomic status,” explained study investigator José López, MD, cardiology fellow at the University of Miami JFK Medical Center, in an interview with HCPLive Cardiology. “Those are the ones who stand to benefit most from this therapy, but we found they were the ones getting it the least.”

During his time at HFSA 2023, López also presented data related to disparities in left ventricular assist device access, which suggested Black race was associated with increased LVAD utilization relative to their non-Hispanic White counterparts. However, Lopez cautioned against overinterpretation of this finding as data indicates White patients were more likely to receive transplants than their Black or Hispanic counterparts.

In the current study, Lopez and a team of investigators sought to leverage the NIS to better understand how socioeconomic status might influence the likelihood of a hospitalized patient receiving an implantable hemodynamic monitor. Through a search of adult admission with a diagnosis of chronic heart failure and received an implantable hemodynamic monitor from 2016 to 2019. The primary outcome of interest for the investigators’ analyses was the rate of implantation per 100,000 admissions within each quartile of median household income, which investigators noted was based on median household income in each zip code.

Overall, 6,546,999 admissions were identified during the aforementioned period. Among this cohort, 0.02% (n=1500) underwent implantable hemodynamic monitor implantation. Of the 1500 patients who received an implantable hemodynamic monitor. This subgroup had a mean age of 68 (Standard deviation [SD], 12.5) years. Investigators pointed out, 285, 340, 370, and 505 patients were categorized as being in the 0-25th, 26th-50th, 51st-75th, and 76th-100th percentiles of median household income, respectively.

Upon analysis, results suggested the rates of implantable hemodynamic monitoring receipt were 14, 20, 24, and 42 per 100,000 among those in the 0-25th percentile, 26th-50th, 51st-75th, and 76th-100th percentiles, respectively. Compared to those in the 0-25th percentile of median household income, those in 26th-50th (Odds Ratio [OR], 1.43; 95% Confidence Interval [CI], 1.01-2.02; P = .044), 51st-75th (OR, 1.63; 95% CI, 1.14-2.34; P = .008), and 76th-100th percentiles (OR, 2.96; 95% CI, 1.99-4.41; P < .001).

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

References:

1. Sekulits A, Lopez J, Burgos MD, et al. Are Implantable Hemodynamic Monitors Accessible to Patients Regardless of Their Socioceomic Status? A National Multicenter Retrospective Cohort Study. Paper presented at: Heart Failure Society of America 2023 Annual Scientific Meeting; October 6 - 9; Cleveland, OH. Accessed October 9, 2023.
2. 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 9, 2023.