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Does Race Influence Decision Making for Advanced Heart Failure Therapies?
Khadijah Breathett1, Erika Yee2, Natalie Pool3
1Division of Cardiovascular Medicine Department of Medicine Sarver Heart Center University of Arizona Tucson AZ.
Journal of the American Heart Association
|November 12, 2019
Summary
Black race modestly influenced decisions for advanced heart failure therapies, particularly during conversations. This suggests allocation processes may be vulnerable to racial bias, impacting patient outcomes.
Area of Science:
- Cardiology
- Medical Decision Making
- Health Equity
Background:
- Race significantly impacts medical decision-making, yet its role in advanced heart failure therapy allocation remains unclear.
- Understanding racial influences is crucial for equitable distribution of life-saving treatments.
Purpose of the Study:
- To investigate whether patient race affects the allocation of advanced heart failure therapies.
- To identify specific decision-making factors and potential biases in therapy allocation.
Main Methods:
- Randomized clinical vignettes varying by patient race (black or white man) presented to heart failure organization members.
- Participants (N=422) completed surveys and think-aloud interviews (n=44) to assess allocation factors.
- Statistical analysis (LASSO, regression) and grounded theory for interview data.
Main Results:
- Surveys showed no overall racial differences in therapy ratings; statistical models found no significant interaction between vignette race and clinical factors.
- However, older participants (≥40 years) showed a modest negative influence of a black vignette on heart transplant allocation.
- Interviews revealed race influenced decision-making steps, with concerns about trust and adherence for the black patient, leading to different therapy recommendations (transplant vs. ventricular assist device).
Conclusions:
- Black race was found to modestly influence heart transplant decision-making, especially in conversational settings.
- Advanced therapy allocation meetings, being conversational, may be susceptible to racial bias.
- Further research and interventions are needed to mitigate bias in advanced heart failure therapy allocation.
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