Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction.

"as some of the data used are covered by data use agreements some of the data that support the findings of this study along with all the programming code are available from the corresponding author upon reasonable request (see data s1 for details).; first data on the number of lvad and ht procedures were obtained using annual state inpatient discharge records from 2010 to 2018 from 19 states (arkansas arizona california colorado iowa illinois kentucky new jersey new york oregon pennsylvania maryland florida georgia north carolina texas virginia wisconsin south carolina; figure s1 ) each state's database contains all inpatient discharge records for all payers from all short-term acute care hospitals except for federally owned hospitals (data s1 ).; we used national health and nutrition examination survey data to obtain estimates of heart failure prevalence by age sex race and ethnicity (data s2 ) finally we obtained data on the incidence of hfref from mesa (multi-ethnic study of atherosclerosis).; for a diverse population of asymptomatic adults enrolled between 2000 and 2002 and followed through 2018 mesa data contain longitudinal information on the diagnosis of heart failure and ejection fraction over a follow-up period of up to 18 5 years (median 16 7 years; data s2 ) the institutional review board at the wake forest university school of medicine approved this study and waived consent as the study used deidentified data.; to identify a subgroup with hfref we estimated the cumulative incidence of reduced ejection fraction among patients with heart failure defined as an ejection fraction <=45% using mesa data and applied the incidence rates by age sex race and ethnicity to obtain estimated counts of the state-level population of adults with hfref (data s2 and table s2 ) we followed the strengthening the reporting of observational studies in epidemiology reporting guidelines.; we identified lvad and ht procedures using the international classification of diseases ninth revision clinical modification ( icd-9-cm ) procedure codes for data from january 1 2010 to september 30 2015 and the tenth revision clinical modification and procedure coding system ( icd-10-cm and icd-10-pcs ) for data from october 1 2015 to december 31 2018 (data s3 and tables s3 and s4 ) we identified potential lvad device exchange on the basis of multiple hospitalizations for the same patient; this analysis was limited to california as data for other states do not permit identification of multiple hospitalizations (data s3 ).; as discharge data are compiled at the hospital level we used the agency for healthcare research and quality guidelines for identifying hospitals with suspect race and ethnicity information and excluded all discharges for all years from these hospitals (data s4 and table s5 ).; see data s1 for details.; see data s1 for details.; data s1-s4 tables s1-s10 figure s1 acknowledgments the authors acknowledge receipt of the state inpatient discharge data from the agency for healthcare research & quality the california department of healthcare access and information the illinois department of public health the pennsylvania health care cost containment council the texas department of state health services and virginia health information; these agencies and their agents and staff bear no responsibility or liability for the results of the analysis which are solely the opinion of the authors."

"Disclosures None."

"Sources of Funding This research was supported by a grant from the National Institute on Minority Health and Health Disparities (R01MD011594, A. Hanchate, PI)."