Introduction: Left-ventricular assist devices (LVAD) and total artificial hearts (TAH) are being increasingly utilized as a bridge to heart transplant (HT). Prior studies have demonstrated disparities in outcomes after HT based on socioeconomic factors such as insurance. This study evaluates the association of insurance type and the time between LVAD/TAH implantation and listing for HT.

Materials and Methods: We identified 16,146 patients listed for HT from 2006 to 2014 in the United Network for Organ Sharing database. Cox proportional hazards model were used to evaluate factors associated with time between LVAD/TAH implantation and HT listing.

Results: Patients with Medicaid were younger, had less hypertension and diabetes mellitus, and were more likely to be initially listed as Status 1. Of the 3618 (22.4%) patients who received LVAD/TAH during the follow-up period, 1669 (46.1%) were implanted prior to HT listing while 1949 (53.95%) were implanted after HT listing. Patients with Medicaid (24.9%) were more likely to receive LVAD/TAH compared to patients with Medicare (23.8%) or private insurance (21.0%) (P<0.0001). There was no difference between insurance groups with respect to whether LVAD/TAH implantation occurred before or after HT listing. Patients with Medicaid experienced the shortest time between LVAD/TAH implantation and HT listing (290.1 ± 250 days) compared to patients with private insurance (300.4 ± 350.3 days) or Medicare (355.5 ± 386.8 days) (P<0.0001). In patients who received LVAD/TAH prior to HT listing, and after adjustment for clinical and demographic covariates, the time from LVAD/TAH implant to HT listing was longer for patients with private (hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.0-1.4; P=0.03) and Medicare (HR 1.5, CI 1.2-1.7; P<0.0001) insurance compared to patients with Medicaid insurance. There was no difference between insurance groups in time from listing to implantation in patients who received LVAD/TAH after being listed for HT.

Conclusion: Patients insured by Medicaid who received LVAD/TAH prior to HT listing had a significantly shorter time between LVAD/TAH implant and HT listing compared to patients with Medicare or private insurance. These data suggest that the Medicaid cohort is sicker at time of evaluation and more urgently requires advanced therapies and HT listing.

CITATION INFORMATION: Schultz W, Yin M, Ko Y.-A, Vega J, Morris A. Medicaid Insurance Is Associated with Shorter Time to Transplant Listing After LVAD Implantation. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress