1431: RACE AND SEX DISPARITIES IN MECHANICAL CIRCULATORY SUPPORT USE: NATIONAL INPATIENT SAMPLE 2018-2022

Introduction: Mechanical circulatory support devices such as extracorporeal membrane oxygenation, intra-aortic balloon pump and percutaneous ventricular assist devices are essential to contemporary cardiogenic shock management. Despite recent advances, evidence on equitable use is mixed, and sex and racial disparities may persist. We evaluated national trends in MCS utilization from 2018 to 2022 across six race-sex strata to determine whether equity has improved or disparities have evolved. Methods: We analyzed 23235 adult discharges with end-stage heart failure in the 2018–2022 National Inpatient Sample, excluding those with DNR orders. Six exposure groups combined race-ethnicity (White, Black, Hispanic) and sex. Survey-weighted logistic regression estimated adjusted annual odds ratios (ORs) for MCS use, including a year x race-sex interaction. Models adjusted for age, payer, ZIP-code income quartile, hospital teaching status/bed size, and Charlson comorbidities. Results: Among the cohort (56.6 % White, 34.1 % Black, 9.3 % Hispanic), MCS use rose from 4.8 % in 2018 to 8.2 % in 2022 (adjusted OR per year, 1.15; 95 % CI, 1.09–1.22; P < 0.001). Interaction terms were significant (P < 0.05), indicating different annual trends by subgroup. By 2022, adjusted odds relative to White men were lower for White women (OR, 0.68; 95 % CI, 0.54–0.86), Black men (OR, 0.76; 95 % CI, 0.61–0.94) and Black women (OR, 0.50; 95 % CI, 0.37–0.69); Hispanic men (OR, 0.89; 95 % CI, 0.64–1.22) and Hispanic women (OR, 0.64; 95 % CI, 0.38–1.08) were non-significant. Despite overall growth, Black women experienced the smallest annual increase, reflecting a widening disparity gap over five years. Conclusions: National MCS use rose from 2018 to 2022, yet adjusted race-sex disparities persisted or widened, especially for Black women. Targeted policies and quality improvement initiatives are needed to ensure equitable access to advanced heart failure therapies.