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07:39
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Disparities in Listing With a Durable Left Ventricular Assist Device After 2018 Heart Allocation Policy Change
Alexander Z Wang1, Molly H White2, Nikhil Narang3
1Department of Medicine, University of Southern California, Los Angeles, California, USA.
JACC. Heart Failure
|August 5, 2026
Summary
After the 2018 heart policy change, vulnerable patients are more likely to receive a bridge-to-transplant (BTT) durable left ventricular assist device (LVAD). This shift may worsen transplant disparities, necessitating policy changes for equitable heart allocation.
Area of Science:
- Cardiovascular Surgery
- Transplant Medicine
- Health Equity Research
Background:
- The 2018 U.S. heart allocation policy shift reduced the use of bridge-to-transplant (BTT) durable left ventricular assist device (LVAD) strategies.
- Previous research indicates BTT LVAD patients face lower transplant rates post-policy.
- Candidates from vulnerable communities exhibit lower post-listing transplant rates.
Purpose of the Study:
- To investigate if the 2018 policy change disproportionately affected BTT LVAD listing rates in vulnerable communities.
- To analyze the impact of neighborhood deprivation on BTT LVAD utilization after policy changes.
Main Methods:
- Utilized data from the Scientific Registry of Transplant Recipients (SRTR) for adult heart transplant candidates (2014-2024).
- Categorized candidates into pre- and post-policy cohorts based on the October 18, 2018 policy change.
- Employed mixed-effects logistic regression analyzing the interaction between Area Deprivation Index (ADI) and policy period for BTT LVAD listing odds.
Main Results:
- The study included 43,342 candidates; BTT LVAD use decreased from 25% pre-policy to 18% post-policy (P < 0.001).
- A significant interaction between ADI and policy period affected BTT LVAD likelihood (P < 0.001).
- Post-policy, the most deprived (10th ADI decile) had 59% higher odds of BTT LVAD listing compared to the least deprived (1st decile) (OR: 1.05, P < 0.001).
Conclusions:
- Post-2018 policy, candidates in more vulnerable communities were increasingly listed with BTT LVADs.
- This practice may exacerbate existing place-based disparities in heart transplant access.
- Policy adjustments are crucial to ensure equity in BTT LVAD listing and heart allocation.
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