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Study shows racial disparities in access to advanced heart failure therapies
Black adults treated at advanced heart failure centers were about half as likely to receive potentially life-changing therapies such as transplants and heart pumps as white adults, possibly because of racial bias, a small study supported by the National Institutes of Health found. Researchers tracked 377 patients treated at one of 21 centers in the United States and found that 62 of 277 white adults (22%) received a heart transplant or a ventricular assist device (VAD), a mechanical device that pumps blood for the heart. In comparison, 11 in 100 black adults (11%) received these therapies for heart failure...
Study shows racial disparities in access to advanced heart failure therapies
Black adults treated at advanced heart failure centers were about half as likely to receive potentially life-changing therapies such as transplants and heart pumps as white adults, possibly because of racial bias, a small study supported by the National Institutes of Health found.
Researchers tracked 377 patients treated at one of 21 centers in the United States and found that 62 of 277 white adults (22%) received a heart transplant or a ventricular assist device (VAD), a mechanical device that pumps blood for the heart. In comparison, 11 in 100 Black adults (11%) received these therapies for end-stage heart failure, which can prolong and improve a patient's quality of life.
The researchers said the findings, which appear in Circulation: Heart Failure, underscore the importance of strengthening equity in clinical decision-making for the 600,000 Americans - particularly Black adults - who suffer from end-stage heart failure. Previous studies have shown that black adults are at higher risk of heart failure and are twice as likely to die from it.
“There are simply too many lives with disability or loss,” said Wendy C. Taddei-Peters, Ph.D., study author and clinical trials project officer in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI). “An immediate step could be to require implicit bias training, particularly for members of the transplant and VAD teams.”
The results come from the Registry Evaluation of Vital Information for VADs in Ambulatory Life (REVIVAL), a two-year observational study supported by NHLBI to better understand the progression of heart failure. This part of the study expands on previous research that analyzed differences in the treatment of advanced heart failure.
For their analysis, researchers controlled for several factors, including disease severity, quality of life, and several social determinants of health, or conditions in the environment in which people live that affect health outcomes. They found no association between patients' race and mortality rates. Eighteen black adults (18%) and 36 white adults (13%) died during the study. Importantly, they found that treatment preferences were similar between the two groups. Still, being Black was associated with a 55% lower rate of receiving VAD therapy or a heart transplant.
The researchers said the findings expanded their current understanding of disparities in heart failure treatment by showing that patients' treatment preferences did not drive the disparities. They added that the striking disparity in treatment that black and white patients actually received, and researchers' inability to explain it by other measures, suggested unconscious bias - and even overt racism and discrimination - among health care providers and within the health system itself had likely come into play.
The totality of evidence suggests that as heart failure providers, we are perpetuating current inequities. However, it is not enough to recognize differences. As physicians and health care providers, we must find ways to create equitable change.”
Thomas M. Cascino, MD, lead author of the study and clinical instructor, Division of Cardiovascular Diseases, University of Michigan at Ann Arbor
In addition to recommending training to help healthcare professionals become aware of their biases, the researchers suggest exploring ways to standardize advanced heart failure therapy. A start could be to use patient registries to identify when and where disparities in clinical care occur.
Typically, doctors refer patients for treatment of advanced heart failure after assessing several factors, such as: B. the patient's cognitive function, his likelihood of taking medication and the nursing help he can receive after treatment.
To support consistency in these assessments and other aspects of clinical care, the researchers said medical centers could work with "disparity experts" who could attend cardiology team meetings and identify key decision points where bias might creep in.
“Disparity experts can identify these biases and barriers in real time, providing learning opportunities and promoting equity,” Taddei-Peters said. “This can be particularly valuable for centers where the demographics of health care providers may not reflect the patients they care for.”
The Centers for Disease Control and Prevention estimates that 6.2 million Americans suffer from heart failure. Common symptoms may include shortness of breath, swelling in the lower body area, e.g. B. on the legs and ankles, as well as fatigue. Underlying risk factors for heart failure, such as diabetes, may also disproportionately affect Black, American Indian, Alaska Native, and Hispanic adults.
Source:
Reference:
Cascino, TM, et al. (2022) Racial inequities in access to ventricular assist devices and transplants persist even after accounting for care preferences: A report from the REVIVAL study. Circulation: heart failure. doi.org/10.1161/CIRCHEARTFAILURE.122.009745.
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