Association between Pre-Implant Employment Status and Left Ventricular Assist Device Outcomes

A. El Rafei, K. Goodwin, J. Schultz, M. Mascotti, C. Martin, A. Shaffer, R. John, R. Cogswell

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Abstract

PURPOSE: Employment status has been linked to worse outcomes in heart failure. Employment status at the time of LVAD evaluation has not been assessed as a predictor of post-LVAD patient outcomes. METHODS: The study cohort consisted of patients who were implanted with continuous flow LVADs at the University of Minnesota between June 2005 and June 2018 who had complete psychosocial evaluation data available. Patients were classified as employed, retired, or unemployed. Cox and negative binomial regression models were used to measure the association between employment status and post LVAD mortality and number of 1 year all cause admission, respectively. RESULTS: The study cohort included 428 patients. Patient were almost equally distributed among the three groups with 157 (37%) unemployed, 135 retired (33%), and 136 employed (32%). Patients who were employed leading up to LVAD implantation had higher socioeconomic status, lower BMIs, and lower reported smoking history (table). Being employed (vs. retired/unemployed) at the time of LVAD evaluation was associated with lower HR for mortality (unadjusted HR 0.50, 95% CI 0.34 - 0.73, P<0.001 - adjusted HR 0.62, 95% CI 0.39 - 0.98, P=0.042). Employed status was also associated with a reduced incidence rate of 1 year readmission (adjusted 27 reduction in incidence rate ratio (IRR) 95% CI 8 % - 63 % reduction, P=0.010). When excluding the retired population, employed vs. unemployed status was not statistically associated with mortality (adjusted HR 0.71, 95 % CI 0.44- 1.11, p = 0.16) however was associated with reduced incidence rates of hospitalization on LVAD support (adjusted 31 % reduction, 95 % CI 11-47 % reduction). CONCLUSION: Patients who were employed at the time of LVAD evaluation had improved survival and lower rates of hospitalization on LVAD support even after adjustment for socioeconomic and clinical variables in this single center analysis.

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