Study: Health Care Providers May Perpetuate Racial Disparities in Heart Failure Treatment

Research supported by the National Institutes of Health (NIH) found Black individuals had a lower rate of receiving a heart transplant (VAD therapy) by 55%, which could be caused by implicit bias, according to the investigators.

“An immediate step could be to require implicit bias training, particularly for transplant and VAD team members,” said Wendy C. Taddei-Peters, PhD, a study author and clinical trials project official within the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI), in a press release.

Previous research identified disparities between race and advanced heart failure treatment, observing that Black adults with end-stage heart failure were more likely to die from it. This study expands on these previous studies in the Registry Evaluation of Vital Information for VADs in Ambulatory Life (REVIVAL) study.

REVIVAL was a 2-year observation study that looked at possible associations between heart failure treatment, disease severity, quality of life, and social determinants of health (environmental factors that affect health outcomes). Researchers identified 377 adult patients receiving treatment for heart failure.

The data suggest that 22% of white adults were treated using VAD, which mechanically pumps blood for the heart. Among Black adults, 11% were treated with end-stage heart failure therapies; however, there were no observed associations between race and rate of death.

“The totality of the evidence suggests that we as heart failure providers are perpetuating current inequities,” said first study author Thomas M. Cascino, MD, a clinical instructor in the Division of Cardiovascular Disease at the University of Michigan at Ann Arbor, in a press release.

Data from the study also show that patient treatment preferences do not drive inequities, rather the inequities may be driven by unconscious bias—possibly deliberate acts racism and discrimination—on behalf of the health care providers, according to the study authors.

“Recognizing disparities isn’t enough. As physicians and health care providers, we must find ways to create equitable change,” Cascino said in the press release.

Health care providers are urged to understand intrinsic biases. These data also led researchers to suggest standardizing advanced heart failure therapy and partnering with “disparity experts” because they can provide learning opportunities and promote equity, according to Taddei-Peters, as well as identifying decisions that may be impacted by unconscious bias.

According to the Centers for Disease Control and Prevention, more than 6.2 million people in the United States are believed to have heart failure. Symptoms may include shortness of breath, lower body swelling—particularly in the legs and ankles, and fatigue.

Diabetes is also a risk factor for heart failure. In the context of this study, it is noteworthy that diabetes can disproportionately impact adults who are Black, American Indian, Alaska Native, and Hispanic.

“The lives disabled or lost are simply too many,” Taddei-Peters said in the press release. “Disparity experts can identify these biases and barriers in real-time, provide learning opportunities, and promote equity.”

Reference

NIH/National Heart, Lung and Blood Institute. NIH-supported study finds racial disparities in advanced heart failure treatment. EurekAlert. October 19, 2022. Accessed on October 19, 2022. eurekalert.org/news-releases/968203.