Healthcare innovation

Black patients and women less likely to…

Black patients and women less likely to…

Heart surgery for patient © Rufous

Black patients and female patients with heart failure who qualify as candidates for surgery have a lower chance of getting that operation than white patients or male patients

A team from the University of Michigan Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation found data from over 12,300 patients with traditional Medicare coverage who qualified to receive a surgical implant for a heart-assisting device to aid their heart failure.

All the patients involved in the data had heart failure severe enough to send them to the hospital at least once in the eight-year study period.

However, data revealed that despite the patients having serious heart conditions, Black patients and women were less likely to receive left-ventricular assist devices (LVAD) and operations for these devices than those of other demographics.

Differences by race and gender persisted even after considering other health factors

The differences for Black patients arose mainly in patients whose chances of benefiting from LVAD were less clear-cut, usually because they had less severe heart failure.

This meant it was up to their health care team and the patient to decide if they wanted to have the operation or continue with non-surgical treatment.

The patterns of LVAD use in women, meanwhile, entails that there was lower access no matter how severe their heart failure anyway.

Differences by race and gender persisted even after the researchers took into account a raft of factors, from patients’ incomes and distance from the hospital to what their neighbourhood population mix was like.

The researchers took from this data that for these patients, the chance of getting an LVAD was influenced by conscious or unconscious race and gender bias on the part of health care providers.

Hospitals need to take steps to ensure more equal access to LVAD

The study also demonstrates that there were no racial differences in LVAD use among the sickest heart failure patients, those who are the most clear-cut candidates.

Instead, the differences in LVAD use for Black patients clustered among those with a less clear-cut need for the device – this can be seriously life threatening to this demographic if these patients do not receive appropriate heart care.

The need for the LVAD, based on specific clinical characteristics, is measured with what’s called an LVAD propensity score.

In the group whose scores were “on the bubble”, Black patients had much lower chances of getting an LVAD than white or male patients.

Black man having heart failure clutching his chest© Andrey Popov

The researchers also looked at what happened after patients received an LVAD

Overall, patients survived for at least a year at equal rates, no matter what their race or gender.

Black patients in the “on the bubble” group actually had a higher chance of surviving at least a year than white patients (84% vs. 77%), even though they had a slightly higher chance of needing another hospital stay. This entails that their candidacy for the LVAD device should be higher than other patients also.

Lead author Thomas Cascino, M.D., M.S., at U-M’s academic medical centre, said: “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.

“There is less aggressive use of this life-saving therapy among a subgroup of Black patients and all women with heart failure.

“While we also need to study the role of patient preference in LVAD decision-making for this group of patients, heart failure providers need to be cognizant of their potential for bias and how it might influence the recommendations we make to patients.”

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