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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Impact of Social Determinants of Health on Utilization of Mechanical Circulatory Support Device in STEMI With
Abdul Rasheed Bahar1, Yasemin Bahar2, George Kidess3
1Department of Internal Medicine, Wayne State University, Detroit, Michigan.
Insights
Mechanical circulatory support (MCS) use for ST-elevation myocardial infarction with cardiogenic shock (STEMI-CS) shows significant disparities. Female, African American, and Asian patients, along with those with lower socioeconomic status, are less likely to receive this life-saving treatment.
Area of Science:
- Cardiology
- Health Services Research
- Health Equity
Background:
- Cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) carries a high mortality rate.
- Mechanical circulatory support (MCS) offers improved outcomes but faces underutilization, particularly in minority populations and women.
- Existing research indicates potential disparities in MCS access and utilization.
Purpose of the Study:
- To evaluate disparities in MCS utilization among STEMI-CS patients.
- To examine the influence of sex, race, and socioeconomic factors on MCS access.
- To identify inequities in the application of advanced cardiac support technologies.
Main Methods:
- Analysis of the Nationwide Inpatient Sample (2016-2021) for STEMI-CS patients.
- Stratification of patients based on MCS utilization.
- Application of multivariate logistic regression and propensity score matching to assess disparities.
Main Results:
- Only 18.8% of 140,820 STEMI-CS patients received MCS.
- Female patients had 30% lower odds of receiving MCS (aOR, 0.70).
- African American (aOR, 0.85) and Asian (aOR, 0.70) patients showed reduced MCS likelihood compared to White patients. Racial disparities were noted among men, not women.
- Lower socioeconomic status (Medicaid recipients) and rural hospital location were associated with decreased MCS use.
Conclusions:
- Significant sex, racial, and socioeconomic disparities exist in MCS utilization for STEMI-CS.
- Targeted interventions are crucial to address health care inequities in this high-risk group.
- Improving equitable access to MCS can enhance outcomes for all STEMI-CS patients.
Background:
Cardiogenic shock (CS) is a severe complication of ST-elevation myocardial infarction (STEMI) with high mortality despite advancements in treatment. Mechanical circulatory support (MCS) devices, such as extracorporeal membrane oxygenation, Impella, and intraaortic balloon pump, have shown promise in improving outcomes but remain underutilized, especially among minority populations and women. This study evaluated disparities in MCS utilization among STEMI-CS patients based on sex, race, and socioeconomic factors.
Methods:
We analyzed data from the Nationwide Inpatient Sample between 2016 and 2021, identifying patients with STEMI-CS using International Classification of Diseases, Tenth Revision codes. Patients were stratified based on MCS utilization. Sociodemographic and hospital characteristics were compared, and multivariate logistic regression and propensity score matching were applied to evaluate disparities and outcomes.
Results:
Among 140,820 patients with STEMI-CS, 18.8% received MCS. MCS recipients were younger, predominantly male (74.2% vs 65.1%; P < .001), and more likely to be treated at urban teaching hospitals (81.8% vs 75%; P < .001). Female patients had 30% lower odds of receiving MCS (adjusted odds ratio [aOR], 0.70; 95% CI, 0.65-0.76; P < .001), while African American (aOR, 0.85; 95% CI, 0.75-0.97; P = .016) and Asian (aOR, 0.70; 95% CI, 0.58-0.85; P < .001) patients were less likely to receive MCS than White patients. Medicaid recipients and rural hospital patients also had reduced odds of MCS utilization. Subgroup analysis revealed racial disparities in MCS utilization among men but not women. MCS use was associated with longer hospital stays (9 vs 7 days) and higher costs ($433,201 vs $191,121).
Conclusions:
This study highlights significant disparities in MCS utilization among STEMI-CS patients, driven by sex, race, and socioeconomic factors. These findings underscore the need for targeted interventions to address health care inequities and improve outcomes in this high-risk population.
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