Introduction
Heart failure has become increasingly prevalent with more than 6.5 million Americans currently impacted (1). Individuals of lower socioeconomic classes are significantly more likely to develop heart failure compared with their wealthier counterparts (2). Differences in the allocation of medical resources, access to quality medical care, ability for self-care, level of education, and generalized support are among the multifactorial reasons that contribute to this disparity (2, 3). Heart transplantation remains the gold standard for patients experiencing end stage heart disease. However, due to the paucity of donor hearts and the multiple contraindications based on strict transplantation recipient criteria, this option is limited to a small select group of individuals (4). When controlling for risk factors for post-transplant mortality, individuals of lower socioeconomic class have also been shown to have worse outcomes and decreased post-transplant survival (3-6). Socioeconomic deprivation may modify several cardiovascular risk factors, making these individuals even less likely to be considered for transplantation. The utilization of alternative therapies is currently thriving. LVADs double the one-year survival rate of patients with end-stage heart failure as compared with drug treatment alone and provide an effective alternative to individuals who are unable to receive a transplant (7, 8). LVADs have also advanced to not only serve as a heart transplantation bridge but also as a destination therapy. These serial improvements have led to the growing use of LVADs in a large percentage of the heart failure population. For individuals of lower socioeconomic classes, numerous studies have shown that these patients more often had an upfront strategy with LVAD implantation compared with remaining on pharmacologic therapy and perpetual waiting on the transplant list (3). The Registry Evaluation of Vital Information for VADs in Ambulatory Life (REVIVAL) study expanded on this by demonstrating that there was a greater preference for individuals with an annual income <$40,000 to receive an LVAD compared with higher income individuals who were significantly more reluctant to accept an LVAD (9). As the technology driving LVADs continues to improve and as more studies demonstrate the benefits of these devices as destination therapy, together with an increased willingness of a population subset to receive these devices, it is important to look at the rate of utilization of these devices across different socioeconomic classes. Our study aims to analyze the current trends and variances in LVAD utilization and to further delve into the reasons for, and implications of, these socioeconomic disparities.