TY - JOUR
T1 - Impact of Socioeconomic Factors on Patient Desire for Early LVAD Therapy Prior to Inotrope Dependence
T2 - Socioeconomic Factors and Preference for LVAD
AU - for the REVIVAL Investigators
AU - Tchoukina, Inna
AU - Shah, Keyur B.
AU - Thibodeau, Jennifer T.
AU - Estep, Jerry D.
AU - Lala, Anuradha
AU - Lanfear, David E.
AU - Gilotra, Nisha A.
AU - Pamboukian, Salpy V.
AU - Horstmanshof, Douglas A.
AU - Mcnamara, Dennis M.
AU - Haas, Donald C.
AU - Jorde, Ulrich P.
AU - Mclean, Rhondalyn C.
AU - Cascino, Thomas M.
AU - Khalatbari, Shokoufeh
AU - Richards, Blair
AU - Yosef, Matheos
AU - Spino, Cathie
AU - Baldwin, J. Timothy
AU - Mann, Douglas L.
AU - Aaronson, Keith D.
AU - Stewart, Garrick C.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/4
Y1 - 2020/4
N2 - Background: Worsening heart failure (HF) and health-related quality of life (HRQOL) have been shown to impact the decision to proceed with left ventricular assist device (LVAD) implantation, but little is known about how socioeconomic factors influence expressed patient preference for LVAD. Methods and Results: Ambulatory patients with advanced systolic HF (n=353) reviewed written information about LVAD therapy and completed a brief survey to indicate whether they would want an LVAD to treat their current level of HF. Ordinal logistic regression analyses identified clinical and demographic predictors of LVAD preference. Higher New York Heart Association (NYHA) class, worse HRQOL measured by Kansas City Cardiomyopathy Questionnaire, lower education level, and lower income were significant univariable predictors of patients wanting an LVAD. In the multivariable model, higher NYHA class (OR [odds ratio]: 1.43, CI [confidence interval]: 1.08–1.90, P = .013) and lower income level (OR: 2.10, CI: 1.18 – 3.76, P = .012 for <$40,000 vs >$80,000) remained significantly associated with wanting an LVAD. Conclusion: Among ambulatory patients with advanced systolic HF, treatment preference for LVAD was influenced by level of income independent of HF severity. Understanding the impact of socioeconomic factors on willingness to consider LVAD therapy may help tailor counseling towards individual needs.
AB - Background: Worsening heart failure (HF) and health-related quality of life (HRQOL) have been shown to impact the decision to proceed with left ventricular assist device (LVAD) implantation, but little is known about how socioeconomic factors influence expressed patient preference for LVAD. Methods and Results: Ambulatory patients with advanced systolic HF (n=353) reviewed written information about LVAD therapy and completed a brief survey to indicate whether they would want an LVAD to treat their current level of HF. Ordinal logistic regression analyses identified clinical and demographic predictors of LVAD preference. Higher New York Heart Association (NYHA) class, worse HRQOL measured by Kansas City Cardiomyopathy Questionnaire, lower education level, and lower income were significant univariable predictors of patients wanting an LVAD. In the multivariable model, higher NYHA class (OR [odds ratio]: 1.43, CI [confidence interval]: 1.08–1.90, P = .013) and lower income level (OR: 2.10, CI: 1.18 – 3.76, P = .012 for <$40,000 vs >$80,000) remained significantly associated with wanting an LVAD. Conclusion: Among ambulatory patients with advanced systolic HF, treatment preference for LVAD was influenced by level of income independent of HF severity. Understanding the impact of socioeconomic factors on willingness to consider LVAD therapy may help tailor counseling towards individual needs.
KW - Ventricular assist device
KW - decision-making
KW - heart failure
KW - socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85077360121&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2019.11.026
DO - 10.1016/j.cardfail.2019.11.026
M3 - Article
C2 - 31809791
AN - SCOPUS:85077360121
SN - 1071-9164
VL - 26
SP - 316
EP - 323
JO - Journal of cardiac failure
JF - Journal of cardiac failure
IS - 4
ER -