Identifying Disparities: Rural-urban comparison in mechanical circulatory support

Open Access
Author:
Alonso, Windy
Graduate Program:
Nursing
Degree:
Doctor of Philosophy
Document Type:
Dissertation
Date of Defense:
March 15, 2017
Committee Members:
  • Judith E. Hupcey, Dissertation Advisor
  • Judith E. Hupcey, Committee Chair
  • Lisa Kitko, Committee Member
  • Jacqueline Mogle, Committee Member
  • Shannon Monnat, Outside Member
Keywords:
  • ventricular assist device
  • heart failure
  • mechanical circulatory support
  • metropolitan status
  • rural-urban
Abstract:
Heart failure (HF) is one of the most prevalent diseases worldwide and the number of people living with advanced or stage D HF is rising. In many cases, advanced HF is refractory to medical treatment and requires the use of more advanced treatments like heart transplantation or ventricular assist device (VAD) therapy. Patients with advanced HF from all metropolitan statuses are being implanted with VADs, yet the impact of different metropolitan statuses has not been adequately explored in the literature. This study aimed to identify and examine outcome disparities between VAD therapy recipients and metropolitan status by comparing rural and urban VAD recipient outcomes in the first twelve months after implantation. Secondary analysis of institutional data maintained by the Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) was completed. VAD recipients were designated as rural or urban using county level data from the U.S. 2010 Census. Kaplan-Meier and Cox proportional hazards models were used to identify differences in hazards between rural and urban VAD recipients. Event counts were analyzed using negative binomial regression. The sample included 158 VAD recipients that were discharged from the hospital following VAD implantation. Twenty-two recipients died in the first twelve months after receiving their device. Nearly 81% of all recipients experienced at least one adverse event during the study period. Although none of the Cox proportional hazards models achieved statistical significance, the Kaplan-Meier event curves seem to suggest rural patients may be at a disadvantage in terms of some adverse events associated with VAD implantation. Until further research with more robust samples of VAD recipients is conducted, these findings seem to indicate no difference in VAD outcomes related to metropolitan status. However, the VAD recipients in this study experienced many adverse events and hospitalizations that may impact HRQoL for VAD recipients irrespective of metropolitan status. Management of complications is an ongoing concern for nurses caring for VAD recipients. New strategies to prevent VAD-related adverse events and poor outcomes are needed. Nursing clinicians and researchers are in a prime position to develop and test these new interventional strategies.