Group Dynamics and Allocation of Advanced Heart Failure Therapies-Heart Transplants and Ventricular Assist Devices-By...

Area of Science:

• Cardiology
• Health Services Research
• Medical Ethics

Background:

• US regulatory framework for advanced heart failure therapies (AHFT) relies on center-level multidisciplinary groups for eligibility decisions.
• Subjective decision-making processes in AHFT allocation are susceptible to racial, ethnic, and gender bias.
• Understanding the influence of group dynamics on AHFT allocation decisions is crucial for equitable care.

Purpose of the Study:

• To investigate how group dynamics impact the allocation of advanced heart failure therapies (AHFT) based on patient gender, race, and ethnicity.
• To assess the relationship between group function scores and AHFT allocation decisions.

Main Methods:

• A mixed-methods study was conducted across 4 AHFT centers, audio-recording meetings for approximately one month.
• Meeting transcripts were analyzed using the de Groot Critically Reflective Diagnoses protocol to assess group function (e.g., challenging groupthink, feedback sharing).
• Hierarchical logistic regression analyzed the association between group function scores and AHFT allocation, adjusting for patient factors and examining interaction effects with gender and race.

Main Results:

• Among 87 patients evaluated, 57% of women and 38% of men received AHFT.
• A statistically significant interaction (P=0.035) was found between group function score and patient gender; higher group function scores increased AHFT allocation probability for women and decreased it for men.
• This gender-based pattern in AHFT allocation associated with group function quality was consistent across racial and ethnic groups.

Conclusions:

• Women evaluated for advanced heart failure therapies were more likely to be allocated AHFT when group decision-making processes demonstrated higher quality.
• The findings highlight the potential for improved group decision-making protocols to mitigate disparities in AHFT allocation.
• Further research is recommended to establish and promote high-quality group decision-making practices to reduce existing disparities in AHFT access.