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Chehade M, Murali KP, Dickson VV, McCarthy MM. Intersection of social determinants of health with ventricular assist device therapy: An integrative review. Heart Lung 2024; 66:56-70. [PMID: 38583277 DOI: 10.1016/j.hrtlng.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) may influence the clinical management of patients with heart failure. Further research is warranted on the relationship between SDOH and Ventricular Assist Device (VAD) therapy for heart failure. OBJECTIVES The purpose of this integrative review was to synthesize the state of knowledge on the intersection of SDOH with VAD therapy. METHODS Guided by Whittemore and Knafl's methodology, this literature search captured three concepts of interest including VAD therapy, SDOH, and their domains of intersection with patient selection, decision-making, treatment outcome, and resource allocation. CINAHL, Embase, PsycINFO, PubMed, and Web of Science were searched in March 2023. Articles were included if they were peer-reviewed publications in English, published between 2006 and 2023, conducted in the United States, and examined VAD therapy in the context of adult patients (age ≥ 18 years). RESULTS 22 quantitative studies meeting the inclusion criteria informed the conceptualization of SDOH using the Healthy People 2030 framework. Four themes captured how the identified SDOH intersected with different processes relating to VAD therapy: patient decision-making, healthcare access and resource allocation, patient selection, and treatment outcomes. Most studies addressed the intersection of SDOH with healthcare access and treatment outcomes. CONCLUSION This review highlights substantial gaps in understanding how SDOH intersect with patient and patient selection for VAD. More research using mixed methods designs is warranted. On an institutional level, addressing bias and discrimination may have mitigated health disparities with treatment outcomes, but further research is needed for implementing system-wide change. Standardized assessment of SDOH is recommended throughout clinical practice from patient selection to outpatient VAD care.
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Affiliation(s)
- Mireille Chehade
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States.
| | - Komal Patel Murali
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
| | - Victoria Vaughan Dickson
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
| | - Margaret M McCarthy
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States
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Lechiancole A, Loforte A, Scandroglio M, Comisso M, Iacovoni A, Maiani M, Gliozzi G, De Bonis M, Musumeci F, Terzi A, Pacini D, Livi U. Does the distance between residency and implanting center affect the outcome of patients supported by left ventricular assist devices? A multicenter Italian study on radial mechanically assisted circulatory support (MIRAMACS) analysis. Artif Organs 2022; 46:1932-1936. [PMID: 35718933 DOI: 10.1111/aor.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/16/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with LVAD require continuous monitoring and care, and since Implanting Centers (ICs) are more experienced in managing LVAD patients than other healthcare facilities, the distance between patient residency and IC could negatively affect the outcomes. METHODS Data of patients discharged after receiving an LVAD implantation between 2010 and 2021 collected from the MIRAMACS database were retrospectively analyzed. The population was divided into two groups: A (n = 175) and B (n = 141), according to the distance between patient residency and IC ≤ or >90 miles. The primary endpoint was freedom from Adverse Events (AEs), a composite outcome composed of death, cerebrovascular accident, hospital admission because of GI bleeding, infection, pump thrombosis, and right ventricular failure. Secondary endpoints were incidences of mortality and complications. All patients were followed-up regularly, according to participating center protocols. RESULTS Baseline clinical characteristics and indications for LVAD did not differ between the two groups. The mean duration of support was 25.5 ± 21 months for Group A and 25.7 ± 20 months for Group B (p = 0.79). At 3 years, freedom from AEs was similar between Group A and Group B (p = 0.36), and there were no differences in rates of mortality and LVAD-related complications. CONCLUSIONS Distance from the IC does not represent a barrier to successful outcomes as long as regular and continuous follow-up is provided.
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Affiliation(s)
- Andrea Lechiancole
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
| | - Mara Scandroglio
- Division of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Marina Comisso
- Cardiothoracic Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Attilio Iacovoni
- Cardiothoracic Department, Papa Giovanni XXII Hospital of Bergamo, Bergamo, Italy
| | - Massimo Maiani
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
| | - Michele De Bonis
- Division of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Amedeo Terzi
- Cardiothoracic Department, Papa Giovanni XXII Hospital of Bergamo, Bergamo, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
| | - Ugolino Livi
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy
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Mehaffey JH, Cullen JM, Hawkins RB, Fonner C, Kern J, Speir A, Quader M, Ailawadi G, Teman N, Yarboro L. Access to Left Ventricular Assist Device: Travel Time Does Not Tell The Whole Story. J Surg Res 2021; 271:52-58. [PMID: 34837734 DOI: 10.1016/j.jss.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Negative health effects of traveling longer distances for surgical services have been reported. Given the high complexity of multidisciplinary care required for management of Left Ventricular Assist Device (LVAD) implantation, only 4 of 18 centers in our state perform these operations. Given the limited access we hypothesized increased travel time would adversely affect postoperative outcomes and 30-d mortality. METHODS A statewide Society of Thoracic Surgeons database was queried to identify patients undergoing Heartmate II/III and HVAD implantation, and 725 patients were identified. Travel time was calculated by zip code. Patients were stratified into regional and distant groups by the upper quartile of travel time (1-h). Preoperative variables and outcomes were compared between the groups. Multivariate analysis was performed to evaluate the impact of travel time in risk-adjusted models of 30-d mortality. RESULTS Median patient travel time to their LVAD center in our state is 32 min (mean 53 ± 65 min, 46 ± 71 miles). Patients in the distant group (n = 191) had lower median incomes, higher self-pay status, higher rates of medical comorbid disease. Despite these differences there was no difference between the groups in ICU and/or hospital length of stay, readmission, postoperative complications, or 30-d mortality. Multivariate regression demonstrated insurance status, age, and prior surgery predicted 30-d mortality, but not travel time. CONCLUSIONS Despite only four centers in the state performing LVAD implantation, travel time was strongly associated with preoperative risk, and socioeconomic status but not postoperative outcomes or 30-d mortality. Therefore, increasing access should focus on insurance, and patient characteristics not travel time.
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Affiliation(s)
- J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - J Michael Cullen
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Clifford Fonner
- Virginia Cardiac Surgery Quality Initiative, Falls Church, Virginia
| | - John Kern
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan Speir
- INOVA Heart and Vascular Institute, Falls Church, Virginia
| | - Mohammed Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas Teman
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Leora Yarboro
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
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Yin MY, Strege J, Gilbert EM, Stehlik J, McKellar SH, Elmer A, Anderson T, Aljuaid M, Nativi-Nicolau J, Koliopoulou AG, Davis E, Fang JC, Drakos SG, Selzman CH, Wever-Pinzon O. Impact of Shared Care in Remote Areas for Patients With Left Ventricular Assist Devices. JACC-HEART FAILURE 2021; 8:302-312. [PMID: 32241537 DOI: 10.1016/j.jchf.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of a shared-care model on outcomes in patients with left ventricular assist devices (LVADs) living in remote locations. BACKGROUND Health care delivery through shared-care models has been shown to improve outcomes in patients with chronic diseases. However, the impact of shared-care models on outcomes in patients with LVAD is unknown. METHODS LVAD recipients in the authors' program (2007 to 2018) were classified based on the levels of care provided and training and resources used: level 1, was defined as outpatient primary care without LVAD-specific care; level 2 was level 1 services and outpatient LVAD-specific care; level 3 was level 2 services and inpatient LVAD-specific care and implantation center (IC). The Kaplan-Meier method was used to compare rates of survival, bleeding, pump thrombosis, infection, neurologic events, and readmissions among levels of care. RESULTS A total of 336 patients were included, with 255 patients (75.9%) cared for in shared-care facilities. Median follow-up was 810 (interquartile range: 321 to 1,096) days. In comparison to patients cared for by IC, patients at levels 2 and 3 shared-care centers had similar rates of death, bleeding, neurologic events, pump thromboses, and infections. However, the rates of death, pump thromboses, and infections were higher for level 1 patients than in IC patients. CONCLUSIONS Shared health care is an effective strategy to deliver care to patients with LVAD living in remote locations. However, patients in shared-care facilities unable to provide LVAD-specific care are at higher risk of unfavorable outcomes. Availability of LVAD-specific care should be strongly considered during patient selection and every effort made to ensure LVAD-specific training and resources are available at shared-care facilities.
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Affiliation(s)
- Michael Yaoyao Yin
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Jennifer Strege
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Edward M Gilbert
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Josef Stehlik
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Stephen H McKellar
- Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Ashley Elmer
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Thomas Anderson
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Mossab Aljuaid
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Jose Nativi-Nicolau
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | | | - Erin Davis
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - James C Fang
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Stavros G Drakos
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Craig H Selzman
- Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Omar Wever-Pinzon
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah.
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Hamdan A, Ortuno S, Guerot E, Aissaoui N. L’assistance monoventriculaire gauche de longue durée : indications, management et complications. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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