Abstract 4145350: Association of Zip Code and Incidence of Driveline Infection in Patients with Left Ventricular Assist Devices (LVADs): Do social determinants of health impact outcomes in LVAD recipients?

Introduction: Driveline infection (DLI) is common after left ventricular assist device (LVAD) implantation and is associated with high morbidity/mortality. Socioeconomic status (SES) is a well-validated risk factor for poor outcomes among patients with heart failure, but its influence on adverse events in patients post-LVAD is poorly understood and may be overestimated. The primary aim of this study was to determine the association between markers of SES and DLI in LVAD recipients. Methods: We conducted a single-center retrospective study of patients who received durable LVAD implants from January 2016 to November 2023. The Distressed Communities Index (DCI), a validated measure of SES, was generated using home zip codes. Baseline patient demographics, insurance, pre-implant device data, and pre-implant laboratory data were also collected. Variables associated with DLI were analyzed with regression and Cox proportional hazard models. Results: Of 159 included patients, 23% were found to have at least one DLI. Patients were categorized as prosperous (29%), comfortable (21%), mid-tier (24%), at-risk (18%), and distressed (8%) based on their DCI, with baseline variables similar across DCI groups. Hispanic ethnicity (17% v 7%, p=0.016) and higher pre-implant BMI (mean 27.5 v 25.6, p=0.017) were associated with DLI (Table 1). While the absolute number of days with LVAD was found to be predictive of DLI (HR 0.998, 95% CI: 0.997-0.999, p=0.001), DCI was not found to be predictive of DLI (HR 1.179 95% CI: 0.918-1.514, p=0.196). Of note, BMI was not predictive (HR 0.983, 95% CI: 0.937-1.031, p=0.475). Conclusion: In this single center population, SES did not independently predict DLI after LVAD implantation. Our study is consistent with the current body of literature in demonstrating that there are no variables consistently associated with DLI, though no study thus far has evaluated SES. This is a key finding, as SES may factor in the assessment of candidacy for LVAD and concern for complications. This may inappropriately bias against LVAD implantation in patients who live in distressed communities. Further studies are necessary to evaluate if DCI impacts other adverse outcomes post LVAD.