Black adults treated at advanced heart failure centers received potentially life-changing therapies, reminiscent of transplants and heart pumps, about half as often as white adults, possibly resulting from racial bias, a small National Institutes of Health-supported study has found.   

Researchers followed 377 patients receiving treatment at certainly one of 21 centers in the US and located that 62 of 277 white adults (22%) received a heart transplant or ventricular assist device (VAD), a machine that pumps blood for the center. As compared, 11 of 100 Black adults (11%) received these end-stage heart failure therapies, which may extend and improve a patient’s quality of life.  

The researchers said the findings, which appear in Circulation: Heart Failure, underscore the importance in strengthening equity in clinical decision-making for the 600,000 Americans – particularly Black adults – who’ve end-stage heart failure. Prior studies have shown Black adults have a greater risk for heart failure and are twice as prone to die from it.    

“The lives disabled or lost are just too many,” said Wendy C. Taddei-Peters, Ph.D., a study creator and clinical trials project official throughout the Division of Cardiovascular Sciences on the National Heart, Lung, and Blood Institute (NHLBI). “An instantaneous step might be to require implicit bias training, particularly for transplant and VAD team members.”  

The findings are from the Registry Evaluation of Vital Information for VADs in Ambulatory Life (REVIVAL), an observational two-year study supported by NHLBI to raised understand the course of heart failure. This a part of the study expands on previous research analyzing disparities in advanced heart failure treatment.  

For his or her evaluation, the researchers controlled for multiple aspects, including disease severity, quality of life, and a number of other social determinants of health, or conditions throughout the environment where people live that affect health outcomes. They didn’t find associations between the patients’ race and death rates. Eighteen Black adults (18%) and 36 white adults (13%) died in the course of the study. Importantly, they found that treatment preferences between the 2 groups were similar. Yet, being Black was related to a 55% reduced rate for receiving VAD therapy or a heart transplant.  

The researchers said the findings expanded on their current understanding of disparities in heart failure treatment by showing that patient treatment preferences didn’t drive the inequities. They added that the notable disparity in treatment that Black and white patients actually received, and the researchers’ inability to elucidate it by other measures, suggested unconscious bias – and even overt racism and discrimination – amongst health care providers and throughout the health care system itself had likely come into play.  

The totality of the evidence suggests that we as heart failure providers are perpetuating current inequities. Nevertheless, recognizing disparities is not enough. As physicians and health care providers, we must find ways to create equitable change.”   

Thomas M. Cascino, M.D., First Study Writer and Clinical Instructor, Division of Cardiovascular Disease, University of Michigan at Ann Arbor

Along with recommending training to assist health care professionals turn out to be aware of their biases, the researchers suggest studying ways to standardize advanced heart failure therapy. Using patient registries to discover when and where disparities in clinical care occur might be a start.   

Typically, physicians refer patients for advanced heart failure therapy after assessing multiple aspects, reminiscent of the patient’s cognitive function, their likelihood of taking medication, and the caregiving help they might receive after treatment.   

To support uniformity in these assessments and other points of clinical care, the researchers said medical centers could partner with “disparity experts” who could join cardiology team meetings and discover pivotal decision-making points where bias may creep in.  

“Disparity experts can discover these biases and barriers in real-time, provide learning opportunities, and promote equity,” Taddei-Peters said. “This may be especially priceless for centers where the demographics of health care providers may not reflect the patients they serve.”

The Centers for Disease Control and Prevention estimates that 6.2 million Americans have heart failure. Common symptoms may include shortness of breath, swelling within the lower body, reminiscent of the legs and ankles, and feeling drained. Underlying risk aspects for heart failure, reminiscent of diabetes, may disproportionately affect Black, American Indian and Alaska Native, and Hispanic adults.

Source:

National Institutes of Health

Journal reference:

Cascino, T.M., et al. (2022) Racial Inequities in Access to Ventricular Assist Device and Transplant Persist After Consideration for Preferences for Care: A Report From the REVIVAL Study. Circulation: Heart Failure. doi.org/10.1161/CIRCHEARTFAILURE.122.009745.