Insurance-Based Disparities in Cardiac Allograft Vasculopathy Following Heart Transplantation Are Mediated by Care at High Volume Centers.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-01-21 DOI:10.1016/j.athoracsur.2025.01.008

Sara Sakowitz, Syed Shahyan Bakhtiyar, Saad Mallick, Sara Pereira, Jennifer Nelson, Rushi Parikh, Robert Higgins, Richard Shemin, Peyman Benharash

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引用次数: 0

Abstract

Background: Socioeconomic disadvantage and Medicaid insurance have been linked with inferior survival following heart transplantation, yet the contributing mechanisms remain to be elucidated. We evaluated the association of Medicaid with the development of cardiac allograft vasculopathy(CAV).

Methods: We considered heart transplant recipients ≥18years within the 2004-2022 Organ Procurement and Transplantation Network. CAV was defined as any evidence of angiographic coronary disease. Institutional volume was computed, with hospitals in the highest quartile (≥19cases/year) categorized as High-Volume Centers. Patients were stratified by insurance into the Medicaid and Non-Medicaid cohorts. The study period was divided into the pre-Affordable Care Act (ACA; 2004-2013) and post-ACA eras (2014-2022).

Results: Of 37,073 heart transplant recipients, 4,875(13%) were insured by Medicaid. The overall incidence of CAV was 31%. Following risk-adjustment, Medicaid insurance was linked with significantly greater likelihood of developing CAV over 5 years (Hazard Ratio[HR] 1.08, 95%Confidence Interval[CI] 1.01-1.16). Importantly, this effect seems to have emerged in the post-ACA era (Pre-ACA HR 1.07, CI 0.84-1.36; Post-ACA HR 1.11, CI 1.02-1.21). Furthermore, among patients at High-Volume Centers, Medicaid insurance was linked with similar CAV likelihood (HR 1.04, CI 0.95-1.14). Yet, considering those treated at non-High-Volume Centers, Medicaid was associated with significantly greater CAV hazard (HR 1.14, CI 1.03-1.26). Overall, Medicaid remained associated with inferior patient (HR 1.31, CI 1.21-1.42) and allograft survival at 5-years (HR 1.29, CI 1.19-1.39).

Conclusions: Medicaid-insured recipients faced inferior survival and greater risk of CAV over 5-years. Our work encourages closer follow-up and treatment for vulnerable populations in the months and years post-transplantation.

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.