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      Racial Inequities in Access to Ventricular Assist Device and Transplant Persist After Consideration for Preferences for Care: A Report From the REVIVAL Study

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          Abstract

          Background:

          Racial disparities in access to advanced therapies for heart failure (HF) patients are well documented, although the reasons remain uncertain. We sought to determine the association of race on utilization of ventricular assist device (VAD) and transplant among patients with access to care at VAD centers and if patient preferences impact the effect.

          Methods:

          We performed an observational cohort study of ambulatory chronic systolic HF patients with high-risk features and no contraindication to VAD enrolled at 21 VAD centers and followed for 2 years in the REVIVAL study (Registry Evaluation of Vital Information for VADs in Ambulatory Life). We used competing events cause-specific proportional hazard methodology with multiple imputation for missing data. The primary outcomes were (1) VAD/transplant and (2) death. The exposures of interest included race (Black or White), additional demographics, captured social determinants of health, clinician-assessed HF severity, patient-reported quality of life, preference for VAD, and desire for therapies.

          Results:

          The study included 377 participants, of whom 100 (26.5%) identified as Black. VAD or transplant was performed in 11 (11%) Black and 62 (22%) White participants, although death occurred in 18 (18%) Black and 36 (13%) White participants. Black race was associated with reduced utilization of VAD and transplant (adjusted hazard ratio, 0.45 [95% CI, 0.23–0.85]) without an increase in death. Preferences for VAD or life-sustaining therapies were similar by race and did not explain racial disparities.

          Conclusions:

          Among patients receiving care by advanced HF cardiologists at VAD centers, there is less utilization of VAD and transplant for Black patients even after adjusting for HF severity, quality of life, and social determinants of health, despite similar care preferences. This residual inequity may be a consequence of structural racism and discrimination or provider bias impacting decision-making.

          Registration:

          URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01369407.

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          Author and article information

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          Journal
          Circulation: Heart Failure
          Circ: Heart Failure
          Ovid Technologies (Wolters Kluwer Health)
          1941-3289
          1941-3297
          October 19 2022
          Affiliations
          [1 ]Division of Cardiovascular Disease (T.M.C., M.M.C., K.D.A.), University of Michigan, Ann Arbor.
          [2 ]Henry Ford Hospital, Detroit, MI (D.E.L.).
          [3 ]Michigan Institute for Clinical and Health Research (B.R., S.K.), University of Michigan, Ann Arbor.
          [4 ]Washington University School of Medicine, St. Louis, MO (D.L.M.).
          [5 ]National Heart, Lung, and Blood Institute, Bethesda, MD (W.C.T.-P., N.J.).
          [6 ]School of Social Work (D.C.W.), University of Michigan, Ann Arbor.
          [7 ]Brigham and Women’s Hospital, Boston, MA (G.C.S.).
          Article
          10.1161/CIRCHEARTFAILURE.122.009745
          36259388
          4e8822b6-b0a8-47e0-86ca-74060c5bb3a7
          © 2022
          History

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