TY  - BOOK
AU  - Ahmed, Sara
AU  - Sheikh, Farooq H
AU  - Tompkins, Shannon
TI  - Disparities in Practice Patterns by Sex, Race, and Ethnicity in Patients Referred for Advanced Heart Failure Therapies
SN  - 0002-9149
PY  - 2022///
KW  - *Heart Failure
KW  - *Heart Transplantation
KW  - *Heart-Assist Devices
KW  - Ethnicity
KW  - Female
KW  - Heart Failure/ep [Epidemiology]
KW  - Heart Failure/th [Therapy]
KW  - Heart-Assist Devices/ae [Adverse Effects]
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Referral and Consultation
KW  - Retrospective Studies
KW  - United States/ep [Epidemiology]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
KW  - Multicenter Study
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - Advanced heart failure (HF) therapies improve survival in patients with stage D HF. We sought to evaluate differences by race/ethnicity and sex in advanced HF therapy referrals and decision-making across a multicenter survey. We performed a retrospective analysis of patients referred for evaluation for advanced HF therapies at 9 centers (n = 515) across the United States. The median age was 58 years, and 73% were male. White patients comprised 55.7% of referrals, whereas non-White patients comprised 44.3%. Non-ischemic etiology was more common in non-White patients (66.6% vs 47.4% p = 0.0005), and ischemic etiology was more common in men (37.8% vs 20.4% p = 0.0005). The primary reason for referral differed by race/ethnicity but not sex, with ventricular arrhythmias (7.6% vs 3%, p = 0.024) and pulmonary hypertension (3.4% vs 0.4% p = 0.018) being more common in White patients, whereas worsening HF was less common (25.4% vs 35.9%; p = 0.009). White patients were offered left ventricular assist devices (LVADs) (60.3% vs 54.7 p = 0.039) and heart transplants (51.8% vs 33.1% p = 0.0007) more often than non-White patients. The preference not to pursue LVAD therapy was more common in non-White patients (17.6% vs 9.6%; p = 0.049). Men were more often declined for a heart transplant because of psychosocial contraindications (34% vs 15%, p = 0.005). In conclusion, in this multicenter analysis of referrals for advanced HF therapies, we observed significant differences by race, ethnicity, and sex in both referral characteristics and evaluation outcomes. Further investigation is warranted to better understand why rates of LVAD and transplantation may be lower in non-White patients who are referred for advanced therapies. Copyright © 2022 Elsevier Inc. All rights reserved
UR  - https://dx.doi.org/10.1016/j.amjcard.2022.09.015
ER  -