Black heart failure patients less likely to get devices and transplants they need, study finds

By Jacqueline Howard and Raenu Charles, CNN

There’s growing evidence that Black heart failure patients are less likely to get advanced therapies than White patients.

A study published Wednesday in the journal Circulation: Heart Failure finds that among a group of adults with heart failure, White people were twice as likely as Black people to receive a heart transplant or a ventricular assist device, a mechanical heart pump often used for patients with end-stage heart failure.

“The totality of the evidence suggests that we as heart failure providers are perpetuating current inequities,” Dr. Thomas Cascino, the study’s first author and a clinical instructor in the Division of Cardiovascular Disease at the University of Michigan at Ann Arbor, said in a news release. “However, recognizing disparities isn’t enough. As physicians and health care providers, we must find ways to create equitable change.”

The researchers analyzed data on 377 adults being treated for heart failure in the United States, among whom 27% identified as Black, between July 2015 and June 2016.

The data showed that a heart transplantation or a ventricular assist device was performed in 11% of the Black patients compared with 22% of the White patients, although death rates were similar in both: 18% in Black patients and 13% in White patients.

The researchers noted that patients’ preferences for ventricular assist devices, heart transplantation or other therapies did not affect the results.

“This residual inequity may be a consequence of structural racism and discrimination or provider bias impacting decision-making,” the researchers wrote.

Experts in the field say the findings offer confirmation of what doctors have been seeing for years.

“I cannot say I’m surprised,” said Dr. Jaimin Trivedi, an associate professor at the University of Louisville School of Medicine who has studied racial disparities among heart patients. He was not involved in the new research.

Trivedi’s recommendation for getting cardiovascular care is to be engaged in your own health journey. Your family or loved ones should be closely involved, too.

The new findings were also not a surprise to Dr. Dave Montgomery, a cardiologist at Piedmont Healthcare in Atlanta.

“The study confirms what has been known for too long, which is that Black heart failure patients have worse outcomes, and that part of the reason for the worse outcomes is a gradient in the quality of care they are offered,” said Montgomery, who also was not involved in the new research.

“While I am not surprised to see the results of this study, I am encouraged by the new information that it provides. These data refute the idea that disparate heart failure outcomes have to do with things like the personal preferences of the patient,” he said. “The problem is not indistinct and unapproachable, as we may have believed in the past. Instead, it shows the distinct inroad to better care for all.”

People should be educated on how to advocate for themselves and ask for options, such as the ventricular assist device, that they might not know about, said Dr. Bessie Young, vice dean for equity, diversity, and inclusion and medical director for the Office of Health Care Equity at UW Medicine.

“There’s just difficulty for certain groups of people to get some of these really life-saving procedures and transplants, and there has to be sort of systemic changes made as to who the gatekeepers are for these devices and how people think about how patients get these devices,” Young said.

Young, a health equities researcher who was not involved in the study, believes that it shows that the disparity is caused by social determinants such as education and access, rather than biological determinants.

As for the study’s implications for health care providers, she said, “there should be equity among people who get these resources, because they’re so limited. And that’s where you have to make sure that people are looking at how they’re assessing people to get a device or transplant, making sure that they’re using some sort of equity lens to do that.”

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