Uncovering Racial Disparities in End-stage Heart Failure Therapies

A recent study supported by the National Institutes of Health (NIH) found that black adults with advanced heart failure were about half as likely as white adults to receive treatments that might improve their quality of life. Although the reasons for this phenomenon remain uncertain, researchers speculated that this might be due to racial bias. The findings of this study were published in the medical journal Circulation: Heart Failure.

Black Communities Less Likely to Receive Life-Prolonging Treatments

The study was conducted at 21 heart failure treatment centers across the United States and followed for two years in the REVIVAL study (Registry Evaluation of Vital Information for VADs in Ambulatory Life). 377 patients enrolled, of whom 100 (26.5%) identified as Black. The results found that 62 of 277 white adults (22%) received a heart transplant or a ventricular assist device (VAD), an electromechanical device for assisting cardiac circulation. In contrast, only 11 of 100 black adults (11%) received these end-stage treatments that could prolong patients’ lives and improve their quality of life.

In this NIH-supported observational cohort study, researchers controlled for various factors, including disease severity, quality of life, and some socio-health determinants or conditions in people’s living environments that affect their health outcomes. Researchers found no association between patient ethnicity and mortality, with 18 black adults (18%) and 36 white adults (13%) succumbing to the disease during the study period. Importantly, they found that treatment preferences were similar between the two groups. However, being ethnically black was associated with a 55% reduction in the rate of receiving VAD treatment or a heart transplant.

The Systematic Bias Existing Unconsciously

According to the Centers for Disease Control and Prevention’s (CDC) estimate, approximately 6.2 million Americans suffer from heart failure. Common symptoms of heart failure include breathlessness, swelling (due to edema) in the lower body, such as legs, ankles, and feet, fatigue and weakness, as well as rapid or irregular heartbeat. Potential risk factors for heart failure, such as diabetes, may also disproportionately affect African Americans, American Indians, Alaska Natives, and Hispanic adults.

Researchers pointed out that previous studies have shown that black adults are at higher risk of heart failure and twice as likely to die from heart failure as other individuals. Therefore, in this ethnic analysis of treatment practices for patients with end-stage heart failure, patient treatment preferences did not lead to inequities but rather unconscious bias among healthcare providers and the healthcare system itself, highlighting an important issue of equity in clinical decision-making. 

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Author

Richard Chau