Abstract 20481: Impact of Insurance Type on Eligibility for Advanced Heart Failure Therapies and Survival
Background: Medicaid patients with advanced heart failure (HF) rarely receive left ventricular assist devices (LVAD) at our center due to significant reimbursement constraints from the Georgia Department of Medicaid. We sought to examine whether insurance type impacts clinical outcomes in patients evaluated for advanced HF therapies (AHFT) at our center.
Hypothesis: Medicaid patients have inferior survival compared to those with private or Medicare insurance.
Methods: We retrospectively identified patients (N=321, age 51.0 ± 12.9 yrs, 70.7% male, 56.7% Black race) evaluated for AHFT including heart transplant or LVAD at Emory University from 2012 to 2014. The outcome of the AHFT evaluation was compared by insurance type using the χ2 or Fisher exact tests. Kaplan Meier analysis and Cox proportional hazards regression were used to estimate the association of insurance type with death.
Results: Compared to patients with private or Medicare insurance, Medicaid patients were younger (P<0.0001), more likely to be Black (P=0.07), had higher eGFR (P=0.004), and lower BMI (P=0.009). The outcome of the evaluation for AHFT varied according to insurance type (P=0.04 for comparison): private insurance 89 (46.1%) listed for HT, 22 (11.4%) DT LVAD, 82 (42.5%) ineligible; Medicare insurance 46 (36.2%) listed for HT, 14 (11.0%) DT LVAD, 67 (52.8%) ineligible; Medicaid insurance 18 (45.0%) listed for HT, 0 (0%) DT LVAD, 22 (55.0%) ineligible. Medicaid patients were more likely to be ineligible for AHFT due to inadequate financial resources (P=0.02) and/or social support (P=0.03), death during the evaluation process (P=0.03), but less likely due to medical comorbidities (P=0.009). In patients who were ineligible for AHFT, there was a trend towards higher risk of death in Medicaid patients (adjusted HR 1.88, 95% CI 0.9 - 3.9, P=0.09, private insurance=REF). There was no difference in survival by insurance in patients who were eligible for AHFT (P=0.7).
Conclusions: Despite younger age and fewer comorbidities, Medicaid patients are less likely to be eligible for AHFT, and have a higher risk of death once deemed ineligible. More research is needed to determine whether worse survival in Medicaid patients who are ineligible for AHFT is a result of limited access to these therapies.
Author Disclosures: A.A. Morris: None. R. Patzer: None. W. Schultz: None. C. Halladay: None. D. Gupta: None. D. Nguyen: None. S. Laskar: None. J. Vega: None. A. Smith: None. V. Phillips: None.
- © 2016 by American Heart Association, Inc.