Black Patients with Heart Failure Half as Likely to Receive Device Therapy, Transplant as White Patients

A report from the REVIVAL study is highlighting a reality plaguing minority populations with heart failure.

An analysis assessing trends in racial disparities in access for ventricular assist devices (VAD) and transplants from the National Institutes of Health (NIH)-sponsored trial, results suggest Black adults in the US were received device therapy or heart transplants half as often as their White counterparts, with evidence indicating preferences for VAD or therapies similar by race and not influencing racial disparities.

“The lives disabled or lost are simply too many,” said study investigator Wendy C. Taddei-Peters, PhD, a study author and clinical trials project official within the Division of Cardiovascular Sciences at the NIH’s National Heart, Lung, and Blood Institute, in a statement. “An immediate step could be to require implicit bias training, particularly for transplant and VAD team members."

A prospective, observational, multicenter patient cohort in ambulatory patients with chronic, advanced, systolic heart failure, the Registry Evaluation of Vital Information for VADs in Ambulatory Life (REVIVAL) study was launched with the intent of providing clinicians with further insight into clinical trajectories of these patients as well as factors that might influence prognosis. In the current study, Taddei-Peters and a steam of colleagues sought to use data from the study to estimate the impact of racial/ethnic background on utilization of VAD therapy and transplant among people with access to care at VAD centers.

Of the 400 patients included in REVIVAL, 377 patients were identified for inclusion in the current analyses. followed for 2 years from 21 VAD centers across the US. This cohort had a mean age of 60.3±11.3 years, 25% were female, and 27% were Black. Compared to their White counterparts, Black participants were younger and less likely to have a caregiver, but no differences were noted in preference for VAD or therapies by race at baseline.

The primary outcomes of interest for the analyses were reception of a VAD or transplant and death. This was assessed using competing events cause-specific proportional hazard methodology with multiple imputation for missing data. Investigators pointed out exposure of interest for their analyses included race, which was defined as Black or White, as well as additional demographics, social determinants of health, clinician-assessed heart failure severity, quality of life, preference for VAD, and desire for therapies.

Upon analysis, results indicated a VAD or transplant occurred among 11% (n=11) of Black participants and 22.3% (n=62) of White participants. Among the 11 Black participants, 8 received a VAD and 3 underwent transplantation. Among the 62 white participants, 43 received a VAD and 19 underwent transplantation. Death occurred among 18% of Black participants and 13% of White participants.

In multivariable analyses, Black race was associated with reduced utilization of VAD and transplant (aHR, 0.45 [95% CI, 0.23-0.85]). Further analysis indicated worse INTERMACS patient profile, lower EQ-VAS, and higher education were more likely to receive a VAD ortransplant. However, investigators underlined the addition of care presences had no impact on any associations.

“The totality of the evidence suggests that we as heart failure providers are perpetuating current inequities,” said lead investigator Thomas M. Cascino, MD, clinical instructor in the Division of Cardiovascular Disease at the University of Michigan at Ann Arbor, in the aforementioned statement. “However, recognizing disparities isn’t enough. As physicians and health care providers, we must find ways to create equitable change.”

This study, “Racial Inequities in Access to Ventricular Assist Device and Transplant Persist After Consideration for Preferences for Care: A Report From the REVIVAL Study,” was published in Circulation: Heart Failure.