Racial, Ethnic, Socioeconomic, and Geographic Inequities in Access to Mechanical Circulatory Support.

Autor:	Nathan AS; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania., Reddy KP; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania., Eberly LA; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania., Fanaroff A; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania., Julien HM; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania., Fiorilli P; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania., Wald J; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Mutaawe S; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Cevasco M; Division of Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Bermudez C; Division of Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Kapur NK; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts., Basir MB; Henry Ford Hospital, Detroit, Michigan., Roswell R; Zucker School of Medicine, Northwell Health, Hofstra University, Hempstead, New York., Groeneveld PW; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Giri J; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	Journal of the Society for Cardiovascular Angiography & Interventions [J Soc Cardiovasc Angiogr Interv] 2023 Oct 25; Vol. 3 (1), pp. 101193. Date of Electronic Publication: 2023 Oct 25 (Print Publication: 2024).
DOI:	10.1016/j.jscai.2023.101193
Abstrakt:	Background: Hospital admissions for cardiogenic shock have increased in the United States. Temporary mechanical circulatory support (tMCS) can be used to acutely stabilize patients. We sought to evaluate the presence of racial, ethnic, and socioeconomic inequities in access to MCS in the United States among patients with cardiogenic shock. Methods: Medicare data were used to identify patients with cardiogenic shock admitted to hospitals with advanced tMCS (microaxial left ventricular assist device [mLVAD] or extracorporeal membranous oxygenation [ECMO]) capabilities within the 25 largest core-based statistical areas, all major metropolitan areas. We modeled the association between patient race, ethnicity, and socioeconomic status and use of mLVAD or ECMO. Results: After adjusting for age and clinical comorbidities, dual eligibility for Medicaid was associated with a 19.9% (95% CI, 11.5%-27.4%) decrease in odds of receiving mLVAD in a patient with cardiogenic shock ( P < .001). After adjusting for age, clinical comorbidities, and dual eligibility for Medicaid, Black race was associated with 36.7% (95% CI, 28.4%-44.2%) lower odds of receiving mLVAD in a patient with cardiogenic shock. Dual eligibility for Medicaid was associated with a 62.0% (95% CI, 60.8%-63.1%) decrease in odds of receiving ECMO in a patient with cardiogenic shock ( P < .001). Black race was associated with 36.0% (95% CI, 16.6%-50.9%) lower odds of receiving ECMO in a patient with cardiogenic shock, after adjusting for Medicaid eligibility. Conclusions: We identified large and significant racial, ethnic, and socioeconomic inequities in access to mLVAD and ECMO among patients presenting with cardiogenic shock to metropolitan hospitals with active advanced tMCS programs. These findings highlight systematic inequities in access to potentially lifesaving therapies.
Databáze:	MEDLINE
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