For the study, researchers examined data on 100 Black patients and 277 white patients treated at one of 21 specialized heart failure centers in the United States. Overall, 11 percent of Black patients received a heart transplant or a mechanical heart pump known as a ventricular assist device (VAD), compared with 22 percent of white patients. This racial disparity in access to care persisted even after researchers accounted for heart failure severity and several so-called social determinants of health, such as whether patients had the resources and caregiving help necessary to aid recovery from these complex medical procedures, researchers reported October 19 in Circulation: Heart Failure. Treatment preferences also didn’t appear to influence the disparities in access to advanced heart failure care — similar proportions of Black and white patients wanted to get heart pumps or transplants. This suggests that unconscious bias or deliberate racial discrimination may have played a role in treatment decisions for these patients, the study team concluded. “The totality of the evidence suggests that we as heart failure providers are perpetuating current inequities,” said the lead study author, Thomas Cascino, MD, a clinical instructor in the division of cardiovascular disease at the University of Michigan at Ann Arbor, in a statement. Black patients were 55 percent less likely than white patients to receive a mechanical heart pump or a transplant. More Black patients died during the study — 18 percent compared with 13 percent of white patients — a difference that was too small to rule out the possibility that it was due to chance. About 6.2 million Americans have heart failure, according to the Centers for Disease Control and Prevention (CDC), and roughly half of them die within five years of diagnosis. Black heart failure patients are more than twice as likely to be hospitalized and up to three times more likely to die of this condition than white patients, some research published in Circulation: Heart Failure in August 2020 suggested. Underlying risk factors for heart failure, such as diabetes, high blood pressure, obesity, and chronic kidney disease are also more common among Black people than white people, research published in Circulation in October 2017 found. Another challenge in heart failure care is that candidates for mechanical heart pumps and transplants must undergo rigorous screening processes designed to ensure that they will be able to keep up with complex medication regimens and follow-up care routines after surgery. To be cleared for these procedures, patients need to pass cognitive tests and also demonstrate that they have caregiving support and an ability to afford and manage all the medication and aftercare. Bias may influence the outcomes of these assessments, contributing to racial disparities in advanced heart failure care, said Wendy C. Taddei-Peters, PhD, an author of the study and a clinical trials project official within the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute, in the statement. Implicit-bias training might help, Dr. Taddei-Peters said. This might mean adding disparity experts to advanced heart failure care teams to identify key points in care decision-making — such as assessments to qualify patients for mechanical pumps or transplants — when bias might negatively impact outcomes. “Disparity experts can identify these biases and barriers in real-time, provide learning opportunities, and promote equity,” Taddei-Peters said. “This can be especially valuable for centers where the demographics of healthcare providers may not reflect the patients they serve.”
