Impact of socioeconomic factors on patient desire for LVAD therapy
Tchoukina I, Shah KB, Thibodeau J, Estep JD, Lala A, Lanfear D, Gilotra N, Pamboukian S, Horstmanshof DA, McNamara D, Haas DC, Jorde U, Forde-McLean R, Khalatbari S, Spino CA, Baldwin J, Mann DL, Aaronson KD, Stewart GC. Impact of socioeconomic factors on patient desire for LVAD therapy. J Heart Lung Transplant. 2018;37(4):S189-S190.
J Heart Lung Transplant
Purpose: While increased heart failure (HF) severity and poor quality of life (QOL) have been associated with the decision to receive a left ventricular assist device (LVAD), we examined if socioeconomic factors were associated with patient willingness to accept an LVAD. Methods: We studied ambulatory patients with advanced HF (n= 400) from the REVIVAL Registry. Subjects were classified into 3 groups based on their responses after receiving basic information about benefits and risks of LVAD therapy: 1-wanting LVAD, 2-unsure, 3-not wanting LVAD to treat their current level ofHF. Logistic regression analysis was performed to identify clinical and demographic predictors of wanting an LVAD. Results: Patient characteristics are shown in Table 1. Lower education level, lower income, worse QOL and higher NYHA class were significant univariable predictors of patients wanting LVAD (p< 0.05 for all). In the multivariable model, higher NYHA class and lower income remained significant independent predictors (p= 0.003 and 0.041, respectively). Every unit increase in NYHA class was associated with a 1.79 times higher odds of wanting LVAD vs. combined unsure and not wanting LVAD. Compared to those with income > $80K, patients with income < $40K and those with income $40K-80K were 2.28 and 2.17 times more likely to want LVAD vs. combined unsure and not wanting LVAD(Table 2). Conclusion: Patients preference for LVAD is influenced by level of income independently of severity ofHF, with greater preference for LVAD among lower and middle tier income groups. Understanding impact ofsocioeconomic factors on patients desire to accept LVADmay help tailor discussion to individual needs (Table presented).