Differential provider decision-making must be addressed to equalize the chances of survival for patients with heart failure, the researchers say:

According to a new study, black people and women with severe heart failure who may be good candidates for surgery to implant a cardiac assist device have fewer prospects to undergo this operation than white clients or male patients.

Differences for black clients emerged primarily among clients whose prospects for benefiting from a left ventricular assist device (LVAD) were less clear cut, usually because they had less severe heart failure. This meant that it was up to their healthcare team and the client to decide whether they wanted to have the surgery or pursue non-surgical treatment.

The patterns of use of the LVAD in women, meanwhile, suggest a lower onset regardless of the severity of their heart failure.

Differences by race and sex persisted even after the researchers took into account a range of factors, from people’s income and distance from the hospital to the composition of the population in their neighborhood.

This raises the strong possibility that for these patients, the likelihood of obtaining an LVAD was influenced by conscious or unconscious racial and gender bias on the part of healthcare providers, the researchers conclude.

And that means hospitals and heart failure teams must take steps to ensure more equal access to LVA care D for all patients who could benefit from it, according to the authors.

The study, published in JAMA Network Open up by a team from the Frankel Cardiovascular Center and the Institute for Health care Coverage and Innovation from the University of Michigan, is based on data from over 12 300 patients benefiting from traditional Medicare coverage. All had heart failure severe enough to send them to the hospital at least once during the eight-year study period.

The study shows no racial difference in LVAD use among the sickest heart failure patients, those who are the clearest candidates.

Instead, differences in LVAD use for black people have been concentrated among those whose need for the device is less clear. This need, 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 clients had significantly lower odds of getting an LVAD than either white or male patients.

Researchers also looked at what happened after customers received an LVAD. Overall, patients survived for at least a year at equal rates regardless of race or gender. Black clients in the “on the bubble” group were actually more likely to survive at least a year than white clients (84% vs. 77%), even though they had a slightly higher risk of requiring another hospital stay.

“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,” says lead author Thomas Cascino, MD, MS, cardiologist and researcher on the health equity in Michigan. Medicine, UM University Medical Center. “There is less aggressive use of this lifesaving therapy among a subset of black clients and all women with heart failure. While we also need to investigate the role of patient preference in LVAD decision-making for this group of patients, heart failure providers need to be aware of their potential for bias and how this might influence recommendations. what we do to patients.

Cascino and colleagues recently examined another factor of heart failure device care – the use of short-term mechanical circulatory guidance in candidate patients. to a heart transplant. This analysis also suggested that center-level variation in utilization plays a major role in this type of care, which in turn could create inequality in the likelihood of a patient being chosen for a heart transplant when an organ becomes available. The team published the article in the Journal of Heart and Lung Transplantation.

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