Background:Due to the high cost of left ventricular assist device (LVAD) therapy, payer type may be an important factor in determining eligibility. How payer type influences outcomes after LVAD implantation is unclear. We, therefore, aimed to study the association of health insurance payer type with outcomes after durable LVAD implantation.Methods:Using STS-INTERMACS (Society of Thoracic Surgeons-Interagency Registry for Mechanically Assisted Circulatory Support), we studied nonelderly adults receiving a durable LVAD from 2016 to 2018 and compared all-cause mortality and postindex hospitalization adverse event episode rate by payer type. Multivariable Fine-Gray and generalized linear models were used to compare the outcomes.Results:Of the 3251 patients included, 26.0% had Medicaid, 24.9% had Medicare alone, and 49.1% had commercial insurance. Compared with commercially insured patients, mortality did not differ for patients with Medicaid (subdistribution hazard ratio, 1.00 [95% CI, 0.75–1.34], P=0.99) or Medicare (subdistribution hazard ratio, 1.09 [95% CI, 0.84–1.41], P=0.52). Medicaid was associated with a significantly lower adjusted incidence rate (incidence rate ratio, 0.88 [95% CI, 0.78–0.99], P=0.041), and Medicare was associated with a significantly higher adjusted incidence rate (incidence rate ratio, 1.16 [95% CI, 1.03–1.30], P=0.011) of adverse event episodes compared with commercially insured patients.Conclusions:All-cause mortality after durable LVAD implantation did not differ significantly by payer type. Payer type was associated with the rate of adverse events, with Medicaid associated with a significantly lower rate, and Medicare with a significantly higher rate of adverse event episodes compared with commercially insured patients.

中文翻译：

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耐用左心室辅助装置植入后健康保险支付者类型和结果的关联：STS-INTERMACS 登记处的分析

背景：由于左心室辅助装置 (LVAD) 治疗的高成本，付款人类型可能是确定资格的重要因素。付款人类型如何影响 LVAD 植入后的结果尚不清楚。因此，我们旨在研究健康保险支付者类型与持久 LVAD 植入后结果的关联。方法：使用 STS-INTERMACS（胸外科医师协会-机械辅助循环支持机构间登记处），我们研究了接受持久 LVAD 的非老年人从 2016 年到 2018 年，按付款人类型比较全因死亡率和指数住院后不良事件发生率。多变量 Fine-Gray 和广义线性模型用于比较结果。结果：在纳入的 3251 名患者中，26.0% 有 Medicaid，24.9% 有单独的 Medicare，49.1% 有商业保险。P = 0.99）或医疗保险（子分布风险比，1.09 [95% CI，0.84–1.41]，P = 0.52）。Medicaid 与显着较低的调整后发病率相关（发病率比，0.88 [95% CI，0.78-0.99]，P = 0.041），而 Medicare 与显着较高的调整后发病率相关（发病率比，1.16 [95 % CI, 1.03–1.30], P= 0.011) 的不良事件事件发生率与商业保险患者相比。结论：持久 LVAD 植入后的全因死亡率在付款人类型上没有显着差异。付款人类型与不良事件发生率相关，与商业保险患者相比，医疗补助的发生率显着降低，而医疗保险的不良事件发生率显着升高。