Abstract 15685: Multicenter Analysis of Advanced Heart Failure Referral Outcomes by Race

Background: Advanced heart failure (AHF) therapies can improve survival in Stage D HF patients. We sought to evaluate racial differences in AHF therapy referrals and decision-making across a multicenter survey. Methods/Results: We performed a retrospective analysis of patients referred for evaluation for AHF therapies at 9 centers (N=515) across the country. Data included: demographics, clinical/referring physician characteristics and evaluation outcomes. By identified racial/ethnic groups, referrals comprised of 55.7% Caucasian, 29.9% African American, 9.1% Hispanic, and 4.7% Asian. Univariate analysis was performed between Caucasian and a combined non-Caucasian group. Most patients were advanced in their disease state, with 47.7% of Caucasian and 55.7% of non-Caucasian patients having EF<20% with a high risk INTERMACS profiles (1-3), 77% and 71.1% respectively. Non-ischemic etiology was more common in non-Caucasians (66.6% vs. 47.4% p=0.001), ischemic etiology more common in Caucasians (41.1% vs. 23.2% p=0.001). The primary reasons for Caucasians to be referred were ventricular arrhythmias (7.6% vs. 3%, p=0.024) and pulmonary hypertension (3.4% vs 0.4% p=0.018), while non-Caucasians were referred most for worsening heart failure (35.9% vs. 25.4% p=0.009). Non-Caucasians were more likely to be declined/deferred for LVAD (45.9% vs. 39.7% p=0.014) or transplantation (48.2% vs. 66.9% p=0.002). Patient preference to not pursue LVAD therapy differed significantly between the groups (Non-Caucasians 17.6% vs. Caucasians 9.6% p=0.022). Conclusions: In this multicenter analysis of referrals for AHF therapies, significant differences exist in referral characteristics and evaluation outcomes between Caucasian and non-Caucasians. The driving factor for not offering LVAD therapy in non-Caucasians was patient preference, raising concerns for potential differences in patient education surrounding AHF therapies between racial groups. Further investigation is needed to explore these differences and why non-Caucasians were more likely to be declined or deferred for LVAD and transplantation.