The Impact of Socioeconomic Status on Living Well in Patients Undergoing Heart Transplantation Versus Left Ventricular Assist Device Implantation

10146 

Abstract Submission 

Brandon Ferrell (1), Albert Dweck (2), Roger Zhu (1), Joseph Khory (2), Justin Olivera (2), Korri Hershenhouse (1), Snehal Patel (1), Daniel Goldstein (1), Stephen Forest (1)

(1) Montefiore Medical Center, Bronx, NY, (2) Albert Einstein College of Medicine, Bronx, NY

Brandon Ferrell    -  Contact Me
Montefiore Medical Center

Albert Dweck    -  Contact Me
Albert Einstein College of Medicine

Roger Zhu    -  Contact Me
Montefiore Medical Center

Joseph Khoury    -  Contact Me
Albert Einstein College of Medicine

Justin Olivera    -  Contact Me
Albert Einstein College of Medicine

Korri Hershenhouse    -  Contact Me
Montefiore Medical Center

Snehal Patel    -  Contact Me
Montefiore Medical Center

*Daniel Goldstein    -  Contact Me
Montefiore Medical Center

Stephen Forest    -  Contact Me
Montefiore Medical Center

Brandon Ferrell    -  Contact Me
N/A

Objective: Left ventricular assist device (LVAD) implantation and orthotopic heart transplantation (OHT) are standard therapies for the treatment of end-stage heart failure. While OHT and LVADs improve survival and quality of life, both have a unique adverse event profile limiting their success. Although the effect of socioeconomic status (SES) on these interventions individually has been previously published, comparing the impact of SES on the long-term outcomes and unique complications after each intervention has not been well reported. We aimed to compare the impact of SES on one-year postoperative outcomes of OHT versus LVAD pts.

Methods: All pts undergoing HeartMate 3 (HM3) implantation or OHT at a quaternary care hospital between August 2017 – December 2021 were eligible for inclusion of this retrospective cohort study. Distressed Community Index (DCI) is a model of social vulnerability that assigns a score from 0 (not distressed) to 100 (severely distressed) to a zip code based on several SES determinants. Pts were stratified as being distressed (DS), DCI >60, or not distressed (ND), DCI <60. Living well was defined as freedom from rehospitalization or complication.

Results: A total of 257 pts met criteria for inclusion, 147 (57%) DS and 110 (43%) ND pts. Baseline characteristics in each cohort were largely similar.

In the DS cohort, there were 76 (52%) OHT and 71 (48%) LVAD recipients. There was no difference in post-operative ICU length of stay (OHT 10 days, LVAD 9 days, p=0.30), though the length of hospital stay was longer in LVAD recipients (22 vs 17 days, p<0.0001). 30-day (OHT 73 (96%), LVAD 63 (89%), p=0.09) and 1-year (OHT 66 (87%), LVAD 59 (83%), p=0.14) survival were similar between each respective intervention. Within the first year of initial discharge, there was not a significant difference in pts readmitted (OHT 50 (66%) vs LVAD 42 (59%), p=0.67). Common indications for readmission were infection or rejection (37, 49%) in OHT pts and bleeding or thrombotic complications (18, 25%) and infection (20, 28%) in LVAD recipients. In total, OHT recipients had a higher median time spent alive outside the hospital in the first year after initial discharge (353 vs 314 days, p=0.001).

In the ND cohort, there were 78 (71%) OHT and 32 (29%) LVAD recipients. Like the DS cohort, there was no difference in post-operative ICU length of stay (8 vs 8 days, p = 0.63) in the ND arm, and the length of hospital stay was longer in LVAD recipients (21 vs 15 days, p=0.002). 30-day (OHT 77 (99%), LVAD 30 (94%), p=0.15) survival was similar between recipients, as was 1-year survival (OHT 73 (94%) vs LVAD 27 (84%), p=0.07). There were significantly more OHT recipients that were readmitted in the first year (54 (69%) vs 12 (38%), p = 0.008) despite no difference in median number of days alive outside the hospital (OHT 359 vs LVAD 346 days, p=0.06). Similar to the DS cohort, common indications for readmission were infection or rejection (39, 50%) in OHT pts and bleeding or thrombotic complications (3, 9%) and infection (4, 13%) in LVAD recipients.

Conclusion: Based on one's SES status, OHT and LVAD recipients have similar 30-day and 1-year survival. OHT pts are more likely to be readmitted than LVAD recipients from ND communities, while OHT recipients from DS communities spend more days alive outside the hospital in the first year in comparison to LVAD pts. LVAD and OHT can safety be performed in pts regardless of SES.

Heart Transplant