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Non-Medical Characteristics Affect Referral for Advanced Heart Failure Services: a Retrospective Review

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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.

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Data Availability

The data that support the findings of this study are not publicly available. Data may be requested for research purposes to investigators with approved data use agreements with Corewell Health.

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Acknowledgements

We thank Western Michigan University for the Graduate College Research Opportunity. Thank you to Indiana University and the NIH for the T32 Postdoctoral Fellowship (5T32DK120524-05) support. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Many thanks to Ruth Kurtycz, PhD, for their statistical expertise and consultation.

Funding

The research was funded in part by a competitive research award toward dissertation research completion (Graduate College Research Opportunity) from Western Michigan University (Catherine Kelty). This publication was also made possible by an NIH-funded postdoctoral fellowship for Catherine Kelty (T32 5T32DK120524-05) within the Indiana University Kidney Training Program.

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Authors and Affiliations

  1. Interdisciplinary Health Sciences PhD Program, Western Michigan University, Kalamazoo, MI, USA

    Catherine E. Kelty, Rob Lyerla & Kieran J. Fogarty

  2. Frederik Meijer Heart & Vascular Institute, Corewell Health, Grand Rapids, MI, USA

    Catherine E. Kelty & Michael G. Dickinson

  3. Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA

    Catherine E. Kelty

  4. Department of Public Health, Davidson College, Davidson, NC, USA

    Kata Chillag

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  1. Catherine E. Kelty
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  5. Kieran J. Fogarty
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Contributions

All authors contributed to study conception and design. Data collection and analysis were performed by Catherine Kelty. All authors contributed to the interpretation of results. The first draft was written by Catherine Kelty, and all authors critically reviewed previous manuscript versions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Catherine E. Kelty.

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Ethics Approval

This research was approved separately by the Corewell Health Institutional Review Board and Western Michigan University Institutional Review Board. Both boards issued non-human subjects research determinations for this study.

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The authors declare no competing interests.

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Kelty, C.E., Dickinson, M.G., Lyerla, R. et al. Non-Medical Characteristics Affect Referral for Advanced Heart Failure Services: a Retrospective Review. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01879-w

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