The impact of race on utilization of durable left ventricular assist device therapy in patients with advanced heart failure.
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2022-11
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Abstract
Background
Heart failure affects >6 million people in the United States alone and is most prevalent in Black patients who suffer the highest mortality risk. Yet prior studies have suggested that Black patients are less likely to receive advanced heart failure therapy. We hypothesized that Black patients would have decreased rates of durable left ventricular assist device (LVAD) implantation within our expansive heart failure program.Methods
A retrospective single-center cohort study was conducted at a single high-volume academic medical center. Patients between 18 and 85 years admitted with a diagnosis of cardiogenic shock or congestive heart failure between 1, 2013 and 12, 2017 with a left ventricular ejection fraction < 30% and inotropic dependence or need for mechanical circulatory support were included. Patients with contraindications to durable LVAD were excluded. An adjusted logistic regression model for durable LVAD implantation within 90 days of the index admission was used to determine the effect of race on durable LVAD implantation.Results
Among the 702 study patients (60.9% White, 34.1% Black), durable LVAD implantation was performed within 90 days of the index admission in 183 (26%) of the cohort. After multivariate analysis, Black patients were not found to have a statistically significant difference in durable LVAD implantation rates compared to White patients in our study (OR: 0.68 [95% confidence interval: 0.45-1.04; p: .074]).Conclusions
Black patients in our study did not have a statistically significant difference in the rate of durable LVAD implantation compared with White patients after adjustments were made for age, sex, socioeconomic, and clinical covariates. Larger prospective studies are needed to validate these findings.Type
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Jones, Mandisa-Maia, Lisa M McElroy, Manal Mirreh, Matthew Fuller, Rebecca Schroeder, Kamrouz Ghadimi, Adam DeVore, Chetan B Patel, et al. (2022). The impact of race on utilization of durable left ventricular assist device therapy in patients with advanced heart failure. Journal of cardiac surgery, 37(11). pp. 3586–3594. 10.1111/jocs.16926 Retrieved from https://hdl.handle.net/10161/32368.
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Scholars@Duke
Lisa M McElroy
I am an abdominal transplant surgeon with a health services research lab focused on understanding how complex health care processes and large multidisciplinary teams affect outcomes of high cost, high acuity patients. I have a master's degree in health services and outcomes research methodology with supplemental training in health disparities research methods, engineering methods for healthcare system and process assessment, organizational behavior theory and change management, and implementation science.
As my research has progressed, an emerging theme has been the interplay between biologic and social risk, which each contribute to a patient’s ultimate success but receive disproportionate consideration in anticipation of and in response to subpar outcomes. I am currently involved in several efforts that build on this concept and employ an approach to health equity research that accounts for center and organizational-level characteristics when examining differences in care based on social determinants of health.
Rebecca Ann Schroeder
Clinical informatics; outcomes research, patient safety and quality; cognitive bias and decision making; transesophageal echocardiographic evaluation and right ventricular function; renal function, delirium and cognitive dysfunction after noncardiac surgery
Kamrouz Ghadimi
Dr. Kamrouz (Kam) Ghadimi is an experienced cardiovascular acute care specialist (cardiovascular anesthesiology and intensive care), established investigator, physician leader, and associate professor of Anesthesiology and Critical Care at Duke Health.
His clinical practice is rooted in the cardiothoracic surgical ICU and operating rooms. He has broad expertise in all topics involving perioperative cardiovascular medicine and intensive care, including the management of acutely ill patients after surgery or those receiving extracorporeal life support (ECLS/ECMO). His specific area of expertise focuses on the enhancement of blood circulation through the lungs and the reversal of bleeding with prevention of thrombosis after surgery and circulatory life support. He has published original research, invited reviews, and guidance documents in several high-impact multidisciplinary journals and networks, including JAMA, Circulation, BMJ, Journal of the American College of Cardiology, Journal of Heart and Lung Transplantation, and Journal of Thrombosis & Haemostasis. He has also published in anesthesiology specialty journals, including Anesthesia & Analgesia, Anesthesiology, Current Opinion in Anesthesiology, and the British Journal of Anaesthesia. Dr. Ghadimi has served on the Editorial Board for the Journal of Cardiothoracic and Vascular Anesthesia since 2018 and has served as a peer reviewer for more than 30 top-medical journals worldwide.
Over his career, he has developed a global multidisciplinary network of collaborators and colleagues in academic medicine, private practice, larger healthcare systems, and offices of the federal government. He has experience with grant funding from a variety of sponsors, including federal, industry, foundation, philanthropy, and institutional sources. He also holds positions on several other national and international committees aimed at improving cardiovascular health in patients undergoing surgery and post-surgical intensive care. He is a selected task force and writing committee member of the 2024 American College of Cardiology and American Heart Association Perioperative Cardiovascular Guidelines. He has devoted the majority of his career to the service of patients requiring cardiovascular perioperative and surgical intensive care.
In addition to a doctorate in Medicine, Dr. Ghadimi holds a Bachelor’s in Economics from Boston University and a Master’s in Clinical Research from Duke University School of Medicine and the National Institutes of Health. He is also an inventor with patents/patents pending, a medical consultant, a mentor, and an investor. He is a founding member and the original academic director of True Learn, an eLearning company focused on board exam preparation for multiple medical subspecialties. This resource is used by many physicians around the country. Beyond developing an educational platform that has reached several thousand physicians and physicians-in-training, Dr. Ghadimi has formally mentored 22 pre-doctorate and post-doctorate trainees, with several mentees continuing their faculty careers in academic practice. In addition, he serves as a resource for a multitude of other physicians, physicians-in-training, and allied healthcare professionals.
Currently, Dr. Ghadimi serves as Director of the Clinical Research Unit for the Department of Anesthesiology at Duke Health, leading a cohesive, high-performing management team that oversees 45 staff working with Anesthesiology faculty and faculty in other departments to operationalize more than 80 innovative research protocols annually (single- and multi-site studies) to advance the fields of perioperative medicine, intensive care, pain management, and brain and heart health. He is leading digital health and artificial intelligence implementation in research workflow to rapidly leverage capabilities for automation and efficiency with the evolving guidance of cybersecurity compliance. He has also led the expansion of the Human Biospecimen Repository within the Department of Anesthesiology, where participants from prospective studies have generously donated biofluids and tissue for the advancement of disease-specific biology and translational research. Dr. Ghadimi is currently involved in the One Duke Gen precision medicine initiative for Duke Health to catalyze high-impact translational discoveries through expansive data-driven partnerships.
Adam David DeVore
Adam D. DeVore, MD, MHS
Dr. DeVore is a cardiologist and Associate Professor of Medicine in the Department of Medicine, Division of Cardiology, at Duke University School of Medicine. His clinical interests include caring for patients and families with heart failure, including those with left ventricular assist devices and heart transplants. He is involved in and leads multiple large studies of patients with heart failure at both Duke University Medical Center and the Duke Clinical Research Institute. He currently serves as the medical director of the Duke Heart Transplant program.
He attended medical school at the University of Chicago Pritzker School of Medicine and completed internal medicine residency at Brigham and Women’s Hospital. He then pursued cardiology training at Duke University and solidified his interests in clinical research and heart failure. He completed a research fellowship at the Duke Clinical Research Institute and a Masters of Health Sciences in Clinical Research before completing an advanced heart failure fellowship at Duke University.
The overarching goals of his research are to advance the current understanding of heart failure through clinical trials as well as develop an evidence base for implementation strategies that addresses the gap between heart failure trial results and clinical practice. For example, he has served on the Steering Committees for large clinical trials, including PIONEER-HF and SPIRRIT-HFpEF. Dr. DeVore also published the first clinical trial conducted within the American Heart Association’s Get With The Guidelines-Heart Failure program, a registry-based cluster randomized trial of quality improvement interventions. He was also the principal investigator for CONNECT-HF, a large-scale, pragmatic, cluster-randomized trial at 161 sites in the US evaluating heart failure quality improvement initiatives. Outside of his work on heart failure, Dr. DeVore is married with 4 children and spends his time corralling them all and coaching youth baseball.
Kevin Lindsey Thomas
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