Left Ventricular Assist Device (LVAD) Outcomes Are Not Adversely Affected by Geographic Variables

Purpose While centers are implanting LVADs in patients from various geographies, the impact of patient geographic variables on LVAD outcomes is unknown. We analyzed individual patient geographic variables as possible risk factors adverse events. Methods and Materials 151 consecutive Heartmate II LVAD recipients from our center surviving implant hospitalization were reviewed for: home distance from implant center, average income of ZIP, rural code, hospital service area (HSA), IMACS class, age, sex, race, strategy (BTT vs DT), and implant date. A subset of 89 patients had full INTERMACS followup event data. Cox proportional hazards model for time to death and time to any event was used, censoring for transplant, adjusting for age, IMACS class, and strategy. Results There were 0.18 deaths/person-year (mean risk time 1.68 years) and 67.4% of patients had ≥ one event at mean time-to-event 159 days. Median distance from center was 42.9 miles with 29% rural patients and 66% living outside the HSA. There was no increased hazard for death or any event for any of the geographic variables examined. Conclusions LVAD recipients living farther away, rurally, outside the HSA, or in less-affluent ZIP codes do not appear to be at increased risk of death or adverse events. Any Event (Cox-Proportional Hazard) * Unadjusted HR (95% CI)Adjusted HR (95% CI)†Distance from Center0.999 (0.996-1.003)0.999 (0.995-1.002)AGI of ZIP (thousands)1.014 (0.992-1.037)1.016 (0.992-1.042)Rural Residence0.605 (0.336-1.090)0.612 (0.335-1.116)Lives outside Implant Center HSA0.701 (0.406-1.208)0.625 (0.356-1.095)*Death, Hospitalization, Bleed, Neurologic Event, Infection, Device Failure †Adjusted for Age, IMACS class, and Strategy Mortality (Cox-Proportional Hazard)Unadjusted HR (95% CI)Adjusted HR * (95% CI)Distance from Center0.988 (0.816-1.2)0.988 (0.81-1.21)AGI of ZIP (thousands)1.012 (0.983-1.042)1.013 (0.984-1.043)Rural Residence0.854 (0.448-1.625)0.855 (0.448-1.631)Lives outside Implant Center HSA0.616 (0.335-1.135)0.615 (0.332-1.141)*Adjusted for Age, IMACS class, and Strategy