Abstract Body (Do not enter title and authors here): Background: Mechanical circulatory support (MCS) is pivotal in treating heart-failure–related cardiogenic shock (HF-CS), yet real-world deployment may hinge on social and institutional forces in addition to clinical need. We quantified predictors of MCS use across racial and ethnic groups.
Methods: The National Inpatient Sample (2016–2020) identified 120,190 adult HF-CS hospitalizations. MCS therapies included intra-aortic balloon pump, percutaneous ventricular assist devices, extracorporeal membrane oxygenation, and heart transplantation. Multivariable logistic regression generated adjusted odds ratios (aORs) for MCS use.
Results: Of all admissions, 60.5 % were White, 25.3 % Black, 7.8 % Hispanic, and 6.4 % Other. MCS was employed in 15.4% of White, 15.2% of Black, 15.1% of Hispanic, and 20.1% of Other patients. Female sex conferred 22–35 % lower odds of receiving MCS (aOR 0.73 in Whites, 0.78 in Hispanics, and 0.65 in Black women; p < 0.01). Patients older than 60 years were likewise less likely to receive support in Hispanics, whites, and blacks (aOR 0.62, 0.68 & 0.75; all p< 0.05). Possessing private insurance increased the likelihood of MCS by 59 % to 151 % (aOR 1.52–2.51, p< 0.05 for all except Asians). Higher income was associated with greater MCS use only among Hispanic patients (aOR 1.27, p = 0.001). Admission to a large-bed-size hospital was the strongest institutional determinant, doubling the odds of support for all groups and up to fourfold in the Others (aOR 4.25, p< 0.001). Medicare/Medicaid coverage showed no significant association with utilisation. Clinically, chronic obstructive pulmonary disease markedly reduced the likelihood of MCS (aOR 0.10–0.65, p ≤ 0.009). Stage-5 chronic kidney disease and atrial fibrillation conferred modestly lower odds only in Whites (aOR 0.75 and 0.80, respectively; p ≤ 0.005) and in patients classified as Other (aOR 0.60 for atrial fibrillation, p = 0.006).
Conclusion: Access to temporary MCS in HF-CS extends beyond clinical eligibility. Women and older adults are less likely to receive support, whereas private insurance, higher income (for Hispanics), and care in large hospitals substantially increase utilisation. Racial and ethnic disparities intersect with socioeconomic status and institutional resources., Black and Hispanic patients—particularly Black women—remain underrepresented among MCS recipients. These findings highlight structural determinants in advanced HF care and underscore the need for targeted.