Study Finds Racial Disparities in Heart Failure Treatment

Black adults treated at advanced heart failure centers received potentially life-changing therapies, such as transplants and heart pumps, about half as often as White adults, possibly due to racial bias. The finding comes from a small NIH-supported study.

Researchers followed 377 patients receiving treatment at one of 21 centers in the U.S. and found that 62 of 277 White adults (22%) received a heart transplant or ventricular assist device (VAD), a mechanical device that pumps blood for the heart. In comparison, 11 of 100 Black adults (11%) received these end-stage heart failure therapies, which can extend and improve a patient’s quality of life.  

Researchers said the findings, which appear in Circulation: Heart Failure, underscore the importance of strengthening equity in clinical decision-making for the 600,000 Americans—particularly Black adults—who have end-stage heart failure. Prior studies have shown Black adults have a greater risk for heart failure and are twice as likely to die from it.

To help address this disparity, “an immediate step could be to require implicit bias training, particularly for transplant and VAD team members,” suggested Dr. Wendy Taddei-Peters, study author and clinical trials project official in NHLBI’s Division of Cardiovascular Sciences.

The findings are from the Registry Evaluation of Vital Information for VADs in Ambulatory Life (REVIVAL), an observational two-year study supported by NHLBI.

For their analysis, the researchers controlled for multiple factors, including disease severity, quality of life and several social determinants of health. Despite that treatment preferences between the two groups were similar, being Black was associated with a 55% reduced rate for receiving VAD therapy or a heart transplant.  

The researchers suggested that unconscious bias—and even overt racism and discrimination—among health care providers and within the health care system itself likely came into play.  

In addition to recommending training, researchers suggest studying ways to standardize advanced heart failure therapy. Using patient registries to identify when and where disparities in clinical care occur could be a start. Medical centers could partner with “disparity experts” to identify pivotal decision-making points where bias may creep in.