title: The impact of insurance and socioeconomic status on outcomes for patients with left ventricular assist devices.
abstract: BACKGROUND
  There has been a steady increase of patients living in the community with Left Ventricular Assist Devices (LVADs). There is a significant gap in our fund of knowledge with respect to the impact that insurance and socioeconomic status has on outcomes for LVAD patients. We thus hypothesize that low neighborhood socioeconomic status and receipt of Medicaid, respectively, lead to earlier readmissions, earlier death, as well as longer time to transplantation among LVAD patients.
  
  
  METHODS
  This was a retrospective review of 101 patients using existing data in the medical information warehouse database at The Ohio State University Medical Center. Primary outcomes measured included time to first event (first readmission or death), death, and time to rehospitalization. Our secondary outcome of interest included time from LVAD implantation to cardiac transplantation.
  
  
  RESULTS
  Recipients of Medicaid did not have an increased risk of adverse events compared with patients without Medicaid coverage. Low Median Household Income (MHI) was associated with an increased risk of readmission (log-rank P = 0.0069) and time to first event (log-rank P = 0.0088). Bridge to transplantation was the only independent predictor of time to death (Hazard Ratio 2.1, [95% confidence interval = 1.03-4.37]). Low MHI and a history of atherosclerosis were both significant predictors for readmission and time to first event. Aldosterone antagonist use decreased the risk of readmission or time to first event by 46%.
  
  
  CONCLUSIONS
  LVAD recipients with a low MHI were more likely to be readmitted to the hospital after LVAD implantation. Whether these patients are adequately monitored on an outpatient basis remains unclear.
authors.affiliation: Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio; Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio; Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio; Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio; Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio. Electronic address: sakima.smith@osumc.edu.
authors.forename: Sakima A
authors.initials: SA
authors.lastname: Smith
authors.affiliation: Cardiac Transplant Program, The Ohio State University Medical Center, Columbus, Ohio; Cardiac Transplant Program, The Ohio State University Medical Center, Columbus, Ohio; Cardiac Transplant Program, The Ohio State University Medical Center, Columbus, Ohio.
authors.forename: Ayesha K
authors.initials: AK
authors.lastname: Hasan
authors.affiliation: Department of Internal Medicine, The Ohio State University, Columbus, Ohio; Department of Internal Medicine, The Ohio State University, Columbus, Ohio; Department of Internal Medicine, The Ohio State University, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio; The Ohio State University College of Public Health, Columbus, Ohio.
authors.forename: Philip F
authors.initials: PF
authors.lastname: Binkley
authors.affiliation: The Ohio State University College of Public Health, Columbus, Ohio; Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007182:Income; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D012189:Retrospective Studies; D012923:Social Class; D014481:United States
keywords: Cardiac transplantation; Left ventricular assist device; Medicaid; Medicare; Socioeconomic status