CARC4: LVAD Use in Minorities: Are We Making Progress?

Background: Published demographic data suggest that black and Hispanic patients are less likely to receive a left ventricular assist device (LVAD) in comparison to white patients. However, this conclusion is based on total implant data and may not capture the true utilization of the technology, independent of access to therapy. We therefore sought to describe the utilization rate of LVADs over time stratified by race in an in-patient setting Methods: Utilizing the National Inpatient Sample (NIS) data from 2013 – 2019, we obtained all patients admitted to the hospital with a primary diagnosis of heart failure and a secondary diagnosis of cardiogenic shock, who then went on to receive an LVAD during that hospitalization. We calculated the annual percentages of non-Hispanic white, nonHispanic black, non-Hispanic other, and Hispanic patients who received an LVAD in order to define an LVAD Utilization Rate (LUR). We also calculated the annual percent differences in LVAD use, defined as the LVAD Utilization Rate Gap (LURGAP), across the racial groups using non-Hispanic whites as the reference. Results: LUR were stable across all racial groups during the defined period, with white patients being implanted at a higher rate than any other racial group (Fig 1). The LURGAP is highest when comparing whites to Hispanic and other (non-black/non-Hispanic) patients and has not narrowed across any racial comparison. When plotted as a linear relationship, the LURGAP has widened comparing white to black patients (WB LURGAP Slope-intercept form y=1.9407x + 33.011 Fig 2). Conclusion: LVADs remain under-utilized in racial minorities despite awareness of this potential disparity. In patients admitted with heart failure complicated by cardiogenic shock, there is a growing underutilization of LVADs in black patients. Further studies are needed to examine this trend more closely.