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Disparities Seen in LVAD Use for Heart Failure in Seniors

Authors say disparities in LVAD use by race, sex likely driven by clinician decision-making

MONDAY, Aug. 1, 2022 (HealthDay News) — Disparities in left ventricular assist device (LVAD) use by race and sex exist among Medicare beneficiaries hospitalized for heart failure and are not explained by clinical characteristics or social determinants of health, according to a study published online July 27 in JAMA Network Open.

Thomas M. Cascino, M.D., from the University of Michigan in Ann Arbor, and colleagues assessed inequities in LVAD use and outcomes according to race and sex. The analysis included 12,310 Medicare beneficiaries admitted for heart failure from 2008 to 2014.

The researchers found that Black beneficiaries were 3.0 percent less likely to receive an LVAD than White beneficiaries, while women were 7.9 percent less likely to receive an LVAD than men. Reduced use was also associated with individual poverty and worse neighborhood deprivation (2.9 and 6.7 percent, respectively), although these measures did little to explain observed disparities. The racial disparity was primarily seen among patients with a low propensity score (propensity score <0.52). On average, one-year survival was similar by race and sex, but Black patients with a low propensity score experienced improved survival (7.2 percent).

“Inequity in LVAD access may have resulted from differences in clinician decision-making because of systemic racism and discrimination, implicit bias, or patient preference,” the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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