Black patients with heart failure receive fewer VADs/transplants, highlighting potential structural racism. Explore implications for equitable treatment access.
Among heart failure patients with high-risk features, there is less utilization of ventricular assist devices (VADs) and transplant among Black patients, with no increase in mortality, according to a study published online Oct. 19 in Circulation: Heart Failure.
Thomas M. Cascino, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted an observational cohort study of ambulatory chronic systolic heart failure patients with high-risk features and no contraindications to VAD to examine the association of race with utilization of VAD. A total of 377 participants were included in the study, of whom 26.5 percent (100 participants) identified as Black.
The researchers found that VAD or transplant was performed in 11 and 22 percent of Black and White participants, and death occurred in 18 and 13 percent, respectively. There was an association observed for Black race with lower utilization of VAD and transplant (adjusted hazard ratio, 0.45), with no increase in death. Similar preferences were seen for VAD or life-sustaining therapies by race; this did not explain racial disparities.
“Although unmeasured patient factors influencing VAD and transplant candidacy cannot be excluded, this residual inequity in VAD and transplant may result from structural racism and discrimination or provider biases impacting clinician decision-making,” the authors write.
Several authors disclosed financial ties to the biopharmaceutical industry.
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