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

Area of Science:

• Cardiology
• Health Services Research
• Health Equity

Background:

• Patients with advanced heart failure (AHF) undergo rigorous evaluation for heart transplantation or left ventricular assist device (LVAD) implantation.
• Access to these advanced therapies hinges on initial referral, which can be influenced by various patient-specific factors.
• This study examines socioeconomic and demographic determinants of AHF referral, specialist visits, and treatment access.

Purpose of the Study:

• To investigate the influence of social and economic factors on the referral process for advanced heart failure (AHF) therapies.
• To identify patient characteristics associated with disparities in accessing heart transplantation or left ventricular assist device (LVAD) evaluations.
• To understand factors affecting subsequent specialist visits and treatment initiation in AHF patients.

Main Methods:

• Retrospective review of 24,258 heart failure patients over 4 years at a single hospital system.
• Analysis of demographic (age, sex, race/ethnicity, language), socioeconomic (insurance, marital status), and behavioral (smoking) variables.
• Statistical methods included Chi-square, ANOVA, logistic regression for mortality, and Cox proportional hazards models for time-to-event.

Main Results:

• Younger, male, and publicly insured patients were more likely to be referred for AHF care.
• Unmarried and smoking patients experienced fewer referrals and clinic visits.
• Younger, White, and Hispanic/Latino patients were more likely to receive transplants, while older, Hispanic/Latino, and smoking patients faced higher 1-year mortality.

Conclusions:

• Significant disparities in access to advanced heart failure (AHF) therapies exist at the pre-evaluation stage.
• Factors such as age, sex, insurance, marital status, ethnicity, and smoking behavior influence referral and treatment access.
• Improving referral and evaluation access is essential for achieving equity in organ allocation and AHF treatment.