DOI: 10.1161/circ.148.suppl_1.17578 ISSN: 0009-7322

Abstract 17578: Improving Access to Care With a Structural Heart Disease Program in a Metropolitan Public Healthcare System

Rafael Harari, Samuel Bernard, Binita Shah, Ambika Nayar, Adam Small, Randal Goldberg, Dan Halpern, Michael DiVita, Kenneth Sutin, sara rostanski, Kaitlyn Lillemoe, Jennifer Cruz, Lindsay Elbaum, peter neuburger, Syed Hussain, Mireia Padilla Lopez, Kah-Loon Wan, Nicolette Kroczynski, Sudheer Jain, Carlos L Alviar, Sripal Bangalore, Norma Keller
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Public hospitals face challenges in providing access to structural heart interventions due to limited resources. Our aim is to describe the implementation and outcomes of a comprehensive, multi-disciplinary Structural Heart Disease Program (SHDP) in the largest public healthcare system in the United States, as a strategy to mitigate healthcare disparities and improve access to care.

Methods: The SHDP at Bellevue Hospital serves as the referral center for 11 public hospitals in New York. It launched in 2022 and added a hybrid OR in March 2023. We collected clinical, demographic, and socioeconomic data for patients undergoing structural heart interventions.

Results: A total of 56 patients were included from January 2022 to June 2023. The median age was 60 years (22-93 years), 59% were women, 41% were Black, 38% Hispanic, 11% White and 9% Asian. Most patients were immigrants (71%), 28.5% were uninsured, 37.5% were undocumented and 41% required an English interpreter. Only 21% of patients completed high school and 9% completed college. The most common procedure was PFO closure (30%) followed by M-TEER and BAV (Figure 1). For TAVRs and M-TEERs combined, the 30-day re-admission rate was 7.1% (n=1) and 30-day mortality was 0%, with no differences by ethnic group. Length of stay varied by procedure and there were low rates of procedural complications (Table 1).

Conclusions: Our multidisciplinary SHDP program demonstrates feasibility to provide care to underserved populations in a public healthcare system with excellent outcomes. Further study of strategies aimed at improving access to structural heart interventions is warranted.

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