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. 2017 Feb;31(2):10.1111/ctr.12875.
doi: 10.1111/ctr.12875. Epub 2016 Dec 19.

Impact of insurance status on heart transplant wait-list mortality for patients with left ventricular assist devices

Sitaramesh Emani  1   2 , Dmitry Tumin  2   3   4 , Randi E Foraker  1   2   5 , Don Hayes Jr  1   2   3   6   7 , Sakima A Smith  1   2
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Impact of insurance status on heart transplant wait-list mortality for patients with left ventricular assist devices

Sitaramesh Emani et al. Clin Transplant. 2017 Feb.

Abstract

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 (HTx) candidates with bridge to transplant left ventricular assist devices (BTT LVADs).

Background: Survival while awaiting HTx has improved with the use of BTT LVADs. 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 HTx 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 HTx 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 HTx wait-list among patients with BTT LVADs, 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.

Keywords: Medicaid; bridge to transplant; left ventricular assist device; wait-list.

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Conflict of interest statement

CONFLICT OF INTEREST

None.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence of wait-list mortality. Cumulative incidence of mortality on the heart transplant waiting list among adult candidates supported by a left ventricular assist device, over time since device implantation
FIGURE 2
FIGURE 2
Cumulative incidence of transplantation. Cumulative incidence of heart transplantation among adult candidates supported by a left ventricular assist device, over time since device implantation
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