Impact of Neighborhood on Cardiovascular Health: A Contemporary Narrative Review.

PURPOSE OF REVIEW: This review summarizes approaches towards neighborhood characterization in relation to cardiovascular health; contemporary investigations relating neighborhood factors to cardiovascular risk and disease; and initiatives to support community-based interventions to address neighborhood-based social determinants related to cardiovascular health. RECENT FINDINGS: Neighborhoods may be characterized by Census-derived measures, geospatial data, historical databases, and metrics that incorporate data from electronic medical records and health information exchange databases. Current research has examined neighborhood determinants spanning racial segregation, access to healthcare and food, educational opportunities, physical and built environment, and social environment, and their relations to cardiovascular health and associated outcomes. Community-based interventions have potential to alleviate health disparities but remain limited by implementation challenges. Consideration of neighborhood context is essential in the design of interventions to prevent cardiovascular disease (CVD) and promote health equity. Partnership with community stakeholders may enhance implementation of programs addressing neighborhood-based health determinants.

De novo human leukocyte antigen allosensitization patterns in patients bridged to heart transplantation using left ventricular assist devices.

INTRODUCTION: We examined the impact and time course of de novo human leukocyte antigen (HLA) allosensitization following left ventricular assist device (LVAD) implantation. METHODS AND RESULTS: Forty patients had a calculated panel reactive antibody (cPRA) prior to LVAD surgery between January 2014 and December 2018. Of these patients, we retrospectively studied 33 patients who had pre-LVAD cPRA <10%. De novo allosensitization was defined as cPRA ≥10% within 3 months following LVAD surgery, and "persistent allosensitization" was defined as cPRA ≥10% at time of heart transplant or death. One-third (11/33) of our cohort developed de novo allosensitization within 3-months post-LVAD. Median duration of follow-up during LVAD support was 588 days (IQR 337-1071 days), or approximately 19 months. In an adjusted, multivariable analysis, female sex remained associated with de novo allosensitization (adjusted odds ratio [95%CI]: 11 (1.4-85), P = 0.026). De novo allosensitization was subsequently associated with persistent allosensitization (P = 0.024). Both axial-flow and centrifugal-flow LVADs had similar rates of allosensitization. Compared to those with no allosensitization, patients with de novo allosensitization did not appear to have inferior post-transplant outcomes of death or treated rejection. CONCLUSION: In our single-center experience, one-third of patients developed de novo allosensitization which did not appear to associate with inferior post-transplant outcomes. Female sex was associated with de novo allosensitization.