Impact of Socioeconomic Factors on Patient Desire for Early LVAD Therapy Prior to Inotrope Dependence

for the REVIVAL Investigators

Research output: Contribution to journalArticle

Abstract

Background: Worsening heart failure (HF) and health-related quality of life (HRQOL) have been shown to impact the decision to proceed with left ventricular assist device (LVAD) implantation, but little is known about how socioeconomic factors influence expressed patient preference for LVAD. Methods and Results: Ambulatory patients with advanced systolic HF (n=353) reviewed written information about LVAD therapy and completed a brief survey to indicate whether they would want an LVAD to treat their current level of HF. Ordinal logistic regression analyses identified clinical and demographic predictors of LVAD preference. Higher New York Heart Association (NYHA) class, worse HRQOL measured by Kansas City Cardiomyopathy Questionnaire, lower education level, and lower income were significant univariable predictors of patients wanting an LVAD. In the multivariable model, higher NYHA class (OR [odds ratio]: 1.43, CI [confidence interval]: 1.08–1.90, P = .013) and lower income level (OR: 2.10, CI: 1.18 – 3.76, P = .012 for <$40,000 vs >$80,000) remained significantly associated with wanting an LVAD. Conclusion: Among ambulatory patients with advanced systolic HF, treatment preference for LVAD was influenced by level of income independent of HF severity. Understanding the impact of socioeconomic factors on willingness to consider LVAD therapy may help tailor counseling towards individual needs.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Heart-Assist Devices
Systolic Heart Failure
Therapeutics
Heart Failure
Quality of Life
Confidence Intervals
Patient Preference
Cardiomyopathies
Counseling
Logistic Models
Odds Ratio
Regression Analysis
Demography
Education

Keywords

  • decision-making
  • heart failure
  • socioeconomic status
  • Ventricular assist device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Socioeconomic Factors on Patient Desire for Early LVAD Therapy Prior to Inotrope Dependence. / for the REVIVAL Investigators.

In: Journal of Cardiac Failure, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Impact of Socioeconomic Factors on Patient Desire for Early LVAD Therapy Prior to Inotrope Dependence",
abstract = "Background: Worsening heart failure (HF) and health-related quality of life (HRQOL) have been shown to impact the decision to proceed with left ventricular assist device (LVAD) implantation, but little is known about how socioeconomic factors influence expressed patient preference for LVAD. Methods and Results: Ambulatory patients with advanced systolic HF (n=353) reviewed written information about LVAD therapy and completed a brief survey to indicate whether they would want an LVAD to treat their current level of HF. Ordinal logistic regression analyses identified clinical and demographic predictors of LVAD preference. Higher New York Heart Association (NYHA) class, worse HRQOL measured by Kansas City Cardiomyopathy Questionnaire, lower education level, and lower income were significant univariable predictors of patients wanting an LVAD. In the multivariable model, higher NYHA class (OR [odds ratio]: 1.43, CI [confidence interval]: 1.08–1.90, P = .013) and lower income level (OR: 2.10, CI: 1.18 – 3.76, P = .012 for <$40,000 vs >$80,000) remained significantly associated with wanting an LVAD. Conclusion: Among ambulatory patients with advanced systolic HF, treatment preference for LVAD was influenced by level of income independent of HF severity. Understanding the impact of socioeconomic factors on willingness to consider LVAD therapy may help tailor counseling towards individual needs.",
keywords = "decision-making, heart failure, socioeconomic status, Ventricular assist device",
author = "{for the REVIVAL Investigators} and Inna Tchoukina and Shah, {Keyur B.} and Thibodeau, {Jennifer T.} and Estep, {Jerry D.} and Anuradha Lala and Lanfear, {David E.} and Gilotra, {Nisha A.} and Pamboukian, {Salpy V.} and Horstmanshof, {Douglas A.} and Mcnamara, {Dennis M.} and Haas, {Donald C.} and Jorde, {Ulrich P.} and Mclean, {Rhondalyn C.} and Cascino, {Thomas M.} and Shokoufeh Khalatbari and Blair Richards and Matheos Yosef and Cathie Spino and Baldwin, {J. Timothy} and Mann, {Douglas L.} and Aaronson, {Keith D.} and Stewart, {Garrick C.}",
year = "2019",
month = "1",
day = "1",
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T1 - Impact of Socioeconomic Factors on Patient Desire for Early LVAD Therapy Prior to Inotrope Dependence

AU - for the REVIVAL Investigators

AU - Tchoukina, Inna

AU - Shah, Keyur B.

AU - Thibodeau, Jennifer T.

AU - Estep, Jerry D.

AU - Lala, Anuradha

AU - Lanfear, David E.

AU - Gilotra, Nisha A.

AU - Pamboukian, Salpy V.

AU - Horstmanshof, Douglas A.

AU - Mcnamara, Dennis M.

AU - Haas, Donald C.

AU - Jorde, Ulrich P.

AU - Mclean, Rhondalyn C.

AU - Cascino, Thomas M.

AU - Khalatbari, Shokoufeh

AU - Richards, Blair

AU - Yosef, Matheos

AU - Spino, Cathie

AU - Baldwin, J. Timothy

AU - Mann, Douglas L.

AU - Aaronson, Keith D.

AU - Stewart, Garrick C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Worsening heart failure (HF) and health-related quality of life (HRQOL) have been shown to impact the decision to proceed with left ventricular assist device (LVAD) implantation, but little is known about how socioeconomic factors influence expressed patient preference for LVAD. Methods and Results: Ambulatory patients with advanced systolic HF (n=353) reviewed written information about LVAD therapy and completed a brief survey to indicate whether they would want an LVAD to treat their current level of HF. Ordinal logistic regression analyses identified clinical and demographic predictors of LVAD preference. Higher New York Heart Association (NYHA) class, worse HRQOL measured by Kansas City Cardiomyopathy Questionnaire, lower education level, and lower income were significant univariable predictors of patients wanting an LVAD. In the multivariable model, higher NYHA class (OR [odds ratio]: 1.43, CI [confidence interval]: 1.08–1.90, P = .013) and lower income level (OR: 2.10, CI: 1.18 – 3.76, P = .012 for <$40,000 vs >$80,000) remained significantly associated with wanting an LVAD. Conclusion: Among ambulatory patients with advanced systolic HF, treatment preference for LVAD was influenced by level of income independent of HF severity. Understanding the impact of socioeconomic factors on willingness to consider LVAD therapy may help tailor counseling towards individual needs.

AB - Background: Worsening heart failure (HF) and health-related quality of life (HRQOL) have been shown to impact the decision to proceed with left ventricular assist device (LVAD) implantation, but little is known about how socioeconomic factors influence expressed patient preference for LVAD. Methods and Results: Ambulatory patients with advanced systolic HF (n=353) reviewed written information about LVAD therapy and completed a brief survey to indicate whether they would want an LVAD to treat their current level of HF. Ordinal logistic regression analyses identified clinical and demographic predictors of LVAD preference. Higher New York Heart Association (NYHA) class, worse HRQOL measured by Kansas City Cardiomyopathy Questionnaire, lower education level, and lower income were significant univariable predictors of patients wanting an LVAD. In the multivariable model, higher NYHA class (OR [odds ratio]: 1.43, CI [confidence interval]: 1.08–1.90, P = .013) and lower income level (OR: 2.10, CI: 1.18 – 3.76, P = .012 for <$40,000 vs >$80,000) remained significantly associated with wanting an LVAD. Conclusion: Among ambulatory patients with advanced systolic HF, treatment preference for LVAD was influenced by level of income independent of HF severity. Understanding the impact of socioeconomic factors on willingness to consider LVAD therapy may help tailor counseling towards individual needs.

KW - decision-making

KW - heart failure

KW - socioeconomic status

KW - Ventricular assist device

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