Racial Disparities In Advanced Heart Failure Therapies: Are Outcomes The Correct Metric?

Purpose Multiple large database studies have shown that African American (AA) patients have worse outcomes after heart transplant compared to white patients, but that outcomes are similar between these groups after left ventricular assist device placement. We sought to compare outcomes after LVAD and heart transplant between different racial groups at our institution. Methods We utilized retrospective databases from our institution that include all patients that underwent heart transplant or LVAD implantation from 2009 to 2020 (323 LVAD patients, 717 heart transplant patients). Patients were stratified by race, and those categorized as white, AA, Hispanic, or Asian were included. Differences between groups were analyzed using t-tests, chi-squared tests, Kaplan Meier analysis, and cox proportional hazards models. Results AA LVAD patients were more likely to be female, and less likely to have diabetes compared to the other groups. AA, Asian, and Hispanic LVAD patients were younger than white LVAD patients. AA heart transplant recipients were less likely to have ischemic cardiomyopathy as the etiology of heart failure. There was no significant difference by log-rank test in one-year survival between races for LVAD patients or heart transplant patients (figure 1). There was a trend towards less AA LVAD patients undergoing transplant among those eligible (81% compared to 97% of white patients, 85% of Asian patients and 90% of Hispanic patients), but this was not statistically significant (p-value 0.06). Conclusion At our institution, there is no significant difference in one-year survival after LVAD implantation or heart transplant by race, but AA patients may be less likely to receive a transplant. These data are important because they suggest we should focus resources on access to care among AA patients. Future work will involve examining the heart failure population within our health system and county to determine if AA patients are offered LVAD and heart transplant at the same rates as white patients.