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Impact of insurance status on heart transplant wait‐list mortality for patients with left ventricular assist devices
Author(s) -
Emani Sitaramesh,
Tumin Dmitry,
Foraker Randi E.,
Hayes Don,
Smith Sakima A.
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12875
Subject(s) - medicine , medicaid , united network for organ sharing , socioeconomic status , ventricular assist device , receipt , heart transplantation , emergency medicine , transplantation , heart failure , health care , environmental health , population , world wide web , computer science , economics , liver transplantation , economic growth
Objectives To test the hypotheses that receipt of Medicaid or Medicare (versus private insurance or self‐pay) and low socioeconomic status ( SES ) leads to increased mortality and lower chances of transplantation among heart transplant ( HT x) candidates with bridge to transplant left ventricular assist devices ( BTT LVAD s). Background Survival while awaiting HT x has improved with the use of BTT LVAD s. However, it is unknown whether benefits extend uniformly across patient groups based on insurance status. Methods Data from the United Network of Organ Sharing ( UNOS ) registry between 2006 and 2015 were examined for first‐time HT x candidates ≥18 and <65 years who had LVAD support while wait‐listed. Multivariable survival analysis was conducted on competing outcomes of mortality and time to transplant stratified by insurance source at the time of listing. Additional covariates included demographic information and SES . Results A total of 4626 patients met inclusion criteria, with 3353 being used for multivariable analysis. A majority of patients (68%) underwent HT x during the study period. BTT LVAD wait‐list mortality was found to be greater among Medicaid beneficiaries vs. private insurance ( SHR 1.57, P <.05) and did not diminish with the inclusion of neighborhood SES . Transplantation as an outcome demonstrated no difference by insurance status. Conclusion Medicaid insurance status is associated with worse survival on the HT x wait‐list among patients with BTT LVAD s, although access to transplant was not different among insurance groups. The disparity is not reflective of SES in general and therefore points to other barriers inherent to Medicaid beneficiaries.