Procedure rates for women, Black men with HFrEF disparate vs. white men
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Key takeaways:
- Women with HFrEF had a 72% lower rate of LVAD use vs. men.
- Black men had a 46% lower rate of heart transplant vs. white men.
- Hispanic men and women and Black women had similar or higher rates vs. white patients.
Despite narrowing sex and racial procedural disparities in HF treatment, gaps persist, with lower rates of left ventricular assist device use and heart transplant among women and Black men vs. their white and male counterparts, data show.
“Though access to advanced heart failure therapies has increased overall, the extent to which women and minority racial/ethnic groups have received such therapies equitably remains unclear,” Scott W. Rose, MD, interventional cardiology fellow at Wake Forest University School of Medicine, and colleagues wrote in the Journal of the American Heart Association. “We used data on LVAD and heart transplant procedures performed from 2010 to 2018 in 19 states that comprise 85% and 70% of the national population of Hispanic and Black adults, respectively. To understand the relationship between denominator choice and procedure rate estimates by sex, race and ethnicity, we improved prior estimates by using the population with HF with reduced ejection fraction and those with heart failure as alternative denominators.”
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To better understand the population rate of LVAD and heart transplant among white, Hispanic and Black men and women with HFrEF, Rose and colleagues gathered data from multiple sources. Data on the number of LVAD and transplant procedures were obtained using annual inpatient discharge records from 19 states; the annual census of adults residing in each state from the American Community Survey was used to estimate the population with HF and HFrEF; National Health and Nutrition Examination Survey data were used to estimate HF prevalence by age, sex, race and ethnicity; and data on the incidence of HFrEF were gained from the Multi-Ethnic Study of Atherosclerosis (MESA).
The primary outcome was number of LVAD and heart transplant procedures per 1,000 adults with HFrEF, and the main exposures were sex, race, ethnicity and age.
In 2018, the estimated number of adults aged 35 to 84 years with HFrEF was 69,736 (44% women).
Among men with HFrEF, the rate of LVAD use was 45.6 per 1,000 adults with HFrEF, and the rate of heart transplant was 26.9 per 1,000 adults with HFrEF.
Compared with men with HFrEF, LVAD use was 72% lower and heart transplant was 62% lower (P < .001) among women with HFrEF, according to the study.
Compared with white men, Black men had 25% lower LVAD use and 46% lower rate of heart transplant (P < .001).
Additionally, Hispanic men and women and Black women, had similar (P > .05) or higher (P < .01) rates of LVAD use or heart transplant compared with their white counterparts, according to the study.
Moreover, the age- and sex-adjusted rates of LVAD use and heart transplant increased across all race and sex subgroups from 2010 to 2018, ranging from a 49.7% increase in LVAD and transplant among white adults with HFrEF to an 89.3% increase among Black adults.
“Inequities in LVAD and heart transplant use are consistent with the ubiquitous disparities in receipt of cardiovascular therapies, specifically in interventions for structural heart disease,” the researchers wrote. “From 2010 to 2018, racial disparities may have narrowed, with a faster increase in LVAD and heart transplant rates among Black adults compared with white adults; nevertheless, there are still significant inequities in the procedure rates.”
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