Non-Medical Characteristics Affect Referral for Advanced Heart Failure Services: a Retrospective Review.
Document Type
Article
Publication Date
2-2025
Publication Title
Journal of racial and ethnic health disparities
Abstract
BACKGROUND: Patients with advanced heart failure (AHF) are extensively evaluated before heart transplantation or left ventricular assist device (LVAD) eligibility. Patients are assessed for medical need and psychosocial or economic factors that may affect success post-treatment. For patients to be evaluated, however, they first must be referred. This study investigated social and economic factors affecting AHF referral, specialist visits, or treatment.
METHODS: Patients with heart failure (n = 24,258) were reviewed at one large hospital system over 4 years. Independent variables age, sex, marital status, race/ethnicity, preferred language, smoking, and insurance status were assessed for the outcomes of referral, clinic visit, and treatment by Chi-square and ANOVA. In-house and 1-year mortality were evaluated by logistic regression, and time-to-event was assessed by the Cox proportional hazards model.
RESULTS: Younger (HR 0.934, 95% CI 0.925-0.943), male (HR 2.216, 95% CI 1.544-3.181), and publicly insured (HR 1.298 [95% CI 1.038, 1.623]) patients were more likely to be referred, while unmarried (HR 0.665, 95% CI 0.488-0.905) and smoking (HR 0.549, 95% CI 0.389-0.776) patients had fewer referrals. Younger, married, and nonsmoking patients were more likely to have a clinic visit. Younger age, White race, and Hispanic/Latino ethnicity were associated with receiving a heart transplant, and LVAD recipients were more likely Hispanic/Latino ethnicity. Advanced age, Hispanic/Latino ethnicity, and smoking were associated with 1-year mortality after heart failure diagnosis.
CONCLUSIONS: Disparities in access exist before evaluation for AHF therapies. Improving access at the levels of referral and evaluation is a necessary step toward achieving equity in organ allocation.
Volume
12
Issue
1
First Page
374
Last Page
383
Recommended Citation
Kelty CE, Dickinson MG, Lyerla R, Chillag K, Fogarty KJ. Non-medical characteristics affect referral for advanced heart failure services: a retrospective review. J Racial Ethn Health Disparities. 2025 Feb;12(1):374-383. doi: 10.1007/s40615-023-01879-w. PMID: 38038903
DOI
10.1007/s40615-023-01879-w
ISSN
2196-8837
PubMed ID
38038903