A new study presented at the Transcatheter Cardiovascular Therapeutics conference, TCT 2023, revealed inequities in access to mechanical circulatory support in United States’ patients with cardiogenic shock. The findings identified stark disparities, particularly among black patients, that further highlight systemic inequities in access to lifesaving therapies. Image courtesy: Getty Images
October 26, 2023 — A new study presented at TCT 2023 revealed inequities in access to mechanical circulatory support in United States’ patients with cardiogenic shock. The findings, simultaneously published in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI), revealed stark disparities, particularly among black patients, that further highlight systemic inequities in access to lifesaving therapies.
The research, “Racial, Ethnic, Socioeconomic, and Geographic Inequities in Access to Mechanical Circulatory Support” was presented as a moderated abstract, titled “Sex and Racial Disparity in Vascular Intervention,” on day three of the Transcatheter Cardiovascular Therapeutics conference, TCT 2023, being hosted Oct. 23-26 in San Francisco, CA, by the Cardiovascular Research Foundation (CRF).
A summary statement from SCAI featured the following details about the presentation of research and presentation at a leading cardiovascular conference.
Lead author of the study, and TCT 2023 presenter, was Ashwin Nathan, MD, MS, an Interventional Cardiologist at the Hospital of the University of Pennsylvania and at the Corporal Michael C. Crescenz VA Medical Center in Philadelphia. He is also an Assistant Professor in the Perelman School of Medicine, and a member of the Penn Cardiovascular Outcomes, Quality & Evaluative Research Center.
“The magnitude of the inequities that we identified in this project are the largest that we have seen within the literature and demonstrate a critically important and urgent issue that needs to be immediately addressed in the care of patients with acute heart failure,” said Nathan.
As noted in the research, cardiogenic shock (CS) is a life-threatening condition in which the heart suddenly cannot pump enough blood to meet the body’s needs. As a result, blood pressure may suddenly drop to dangerous levels, and if CS isn’t diagnosed and treated quickly, it’s often fatal. The research summary also noted that, although CS is rare and cases are decreasing due to improved treatment options like innovative interventional procedures, approximately 40,000 to 50,000 cases still occur yearly in the United States.
Using Medicare claims data, researchers identified large and significant racial, ethnic, and socioeconomic inequities in access to mechanical circulatory support. The data was used to identify patients with cardiogenic shock admitted to hospitals with advanced tMCS (microaxial left ventricular assist device (mLVAD) or extracorporeal membranous oxygenation (ECMO)) capabilities within the 25 largest core-based statistical areas, all major metropolitan areas.
After adjusting for age and clinical comorbidities, dual eligibility for Medicaid was associated with a 19.9% (95% CI, 11.5% to 27.4%) decrease in odds of receiving mLVAD in a patient with cardiogenic shock (P<0.001). After adjusting for age, clinical comorbidities and dual eligibility for Medicaid, Black race was associated with 36.7% (95% CI, 28.4% to 44.2%) lower odds of receiving mLVAD in a patient with cardiogenic shock. Dual eligibility for Medicaid was associated with a 62.0% (95% CI, 60.8% to 63.1%) decrease in odds of receiving ECMO in a patient with cardiogenic shock (P<0.001). Black race was associated with a 36.0% (95% CI 16.6% to 50.9%) lower odds of receiving ECMO in a patient with cardiogenic shock, after adjusting for Medicaid eligibility.
Researchers noted several limitations to the study, including patient-level access, which was limited to Medicare beneficiaries, which limited age range, and only beneficiaries with a diagnosis of cardiogenic shock. Less than 0.6% of the study participants received any form of tMCS, which limits the generalizability of the findings. They noted that despite the limitations, the stark differences in utilization between marginalized and non-marginalized groups highlight significant inequities.
Co-authors with Nathan included: Kriyana P. Reddy, BS; Lauren A. Eberly, MD, MPH; Alexander Fanaroff, MD, MHS; Howard M. Julien, MD, MPH, ML; Paul Fiorilli, MD; Joyce Wald, MD; Shafik Mutaawe, MD; Marisa Cevasco, MD, MPH; Christian Bermudez, MD; Navin K. Kapur, MD; Mir Babir Basir, DO; Robert Roswell, MD; Peter W. Groeneveld, MD, MS; and Jay Giri, MD, MPH.
The Society for Cardiovascular Angiography & Interventions (SCAI) is a non-profit professional association with over 4,500 members representing interventional cardiologists and cardiac catheterization teams in the United States. SCAI promotes excellence in interventional cardiovascular medicine for both adults and children through education, representation, and the advancement of quality standards to enhance patient care.
More information: www.scai.org
Find more of DAIC's TCT 2023 news coverage here
April 28, 2023 
