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Racial differences in outcomes after receiving advanced heart failure therapies
Rebecca S Steinberg1, Aditi Nayak, Alanna A Morris
1Division of Cardiology, Emory University, Atlanta, Georgia, USA.
Current Opinion in Cardiology
|March 20, 2021
Summary
Racial and ethnic disparities persist in advanced heart failure treatments like heart transplantation and left ventricular assist devices (LVAD). While outcomes after LVAD are similar across races, Black patients face lower survival post-transplant due to complex factors.
Area of Science:
- Cardiology
- Transplantation immunology
- Health disparities research
Background:
- Advanced heart failure therapies, including heart transplantation and left ventricular assist devices (LVAD), have improved, yet significant racial/ethnic disparities in clinical outcomes remain.
- Public policy and medical advancements have not fully mitigated these persistent outcome gaps.
Purpose of the Study:
- To review and describe racial/ethnic disparities in outcomes for patients undergoing heart transplantation and LVAD implantation.
- To explore the current understanding of factors contributing to these disparities in advanced heart failure care.
Main Methods:
- This is a review article, synthesizing existing literature on race/ethnicity and outcomes in advanced heart failure therapies.
- Analysis of factors contributing to disparities, including patient demographics, clinical status at referral, immunological responses, and socioeconomic factors.
Main Results:
- Black and Latinx patients are increasingly receiving advanced therapies but present with worse hemodynamic profiles at referral.
- Black patients exhibit lower survival rates post-heart transplantation, linked to higher rates of cellular/humoral rejection, allosensitization, and de-novo donor-specific antibodies.
- While psychosocial risks were previously implicated, they appear less correlated with outcomes after LVAD, where outcomes are similar across racial groups.
Conclusions:
- Race/ethnic minorities, particularly Black and Latinx individuals, are often sicker upon referral for advanced heart failure interventions.
- While LVAD outcomes appear comparable across races, Black patients face persistent challenges in post-transplant survival due to a complex interplay of immunologic, clinical, and socioeconomic factors.
- Addressing disparities requires a multifaceted approach, considering the combined impact of various contributing factors rather than isolated elements.
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