Heart failure

Black patients and women less likely to receive care for heart failure

© Roux

Black patients and female patients with heart failure who qualify as candidates for surgery are less likely to have surgery than white patients or male patients

A team from the Frankel Cardiovascular Center and the Institute for Healthcare Policy and Innovation at the University of Michigan found data from more than 12,300 patients with traditional Medicare coverage who qualified to receive a surgical implant for a cardiac assist device to help their heart failure.

All of the patients involved in the data had heart failure severe enough to send them to hospital at least once during the eight-year study period.

However, the data revealed that despite patients suffering from severe heart problems, Black patients and women were less likely to receive left ventricular assist devices (LVADs) and operations of these devices than those of other demographic groups.

Differences by race and gender persist even after controlling for other health factors

The differences for black patients occurred mainly in patients whose chances of benefiting from LVAD were less clear, usually because they had less severe heart failure.

This meant that it was up to their healthcare team and the patient to decide whether they wanted to have the operation or pursue non-surgical treatment.

Patterns of LVAD use in women, meanwhile, imply that there was lower access anyway, regardless of the severity of their heart failure.

Differences by race and gender persisted even after the researchers took into account a range of factors, from patients’ incomes and distance from the hospital to the makeup of their neighborhood’s population.

The researchers inferred from these data that for these patients, the odds of getting an LVAD were influenced by conscious or unconscious racial and gender bias on the part of healthcare providers.

Hospitals must take steps to ensure more equitable access to LVAD

The study also demonstrates that there were no racial differences in LVAD use among the sickest heart failure patients, who are the clearest candidates.

Instead, differences in LVAD use for black patients have been concentrated among those with a less clear need for the device – it can be seriously life-threatening for this demographic if these patients do not receive appropriate cardiac care.

The need for LVAD, based on specific clinical characteristics, is measured with what is called an LVAD propensity score.

In the group whose scores were “on the bubble,” black patients were significantly less likely to get an LVAD than white or male patients.

Black man with heart failure clutching his chest
© Andrei Popov

Researchers also looked at what happened after patients were given an LVAD

Overall, patients survived for at least a year at equal rates regardless of race or gender.

Black patients in the “on the bubble” group were actually more likely to survive at least a year than white patients (84% vs. 77%), although they had a slightly higher risk of needing another hospital stay. This implies that their candidacy for the LVAD device should also be higher than that of other patients.

Lead author Thomas Cascino, MD, MS, at UM’s Academic Medical Center, said, “These data show clear racial disparities in cases where there is ‘wiggle room’ for clinicians to decide which patients are most likely to benefit from an LVAD.

“There is less aggressive use of this lifesaving therapy in a subset of black patients and all women with heart failure.

“While we also need to investigate the role of patient preference in LVAD decision-making for this patient group, heart failure providers should be aware of their potential for bias and how this might influence outcomes. recommendations we make to patients.”

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