Emory University, Division of Cardiology, Atlanta, Georgia, USA.
Emory Transplant Center, Emory Healthcare, Atlanta, Georgia, USA.
Clin Transplant. 2022 Jan;36(1):e14502. doi: 10.1111/ctr.14502. Epub 2021 Oct 26.
Caregiver support is considered necessary after heart transplant (HT) and left ventricular assist device (LVAD) for patients with end-stage heart failure (HF). Few studies have demonstrated how caregivers differ by gender and race, and whether that impacts therapy eligibility.
We examined caregiver relationships among 674 patients (32% women, 55% Black) evaluated at Emory University from 2011 to 2017. Therapy readiness was assessed using the Stanford Integrated Assessment for Transplant (SIPAT). Evaluation outcome according to caregiver relationship was compared using χ analysis. Multivariable logistic regression determined the association between caregiver and eligibility according to gender and race.
Women and Black patients were less likely to have spouses as their support person (P < .001). Women were less likely to be considered eligible for advanced therapies (adjusted odds ratio [aOR] .64, 95% confidence interval [CI] .46-.89; P = .008), with Black women having lower eligibility than White women (aOR .28, 95% CI .11-.72; P = .008). Social support and SIPAT scores did not significantly influence eligibility by gender or race.
Lack of caregiver support is considered a relative contraindication to advanced therapies. Type of caregiver in our cohort varied according to race and gender but did not explain differences in eligibility for advanced therapies.
对于终末期心力衰竭（HF）患者，心脏移植（HT）和左心室辅助装置（LVAD）后需要 caregiver 的支持。很少有研究表明 caregiver 如何因性别和种族而有所不同，以及这是否会影响治疗资格。
我们检查了 2011 年至 2017 年期间在埃默里大学接受评估的 674 名患者（32%为女性，55%为黑人）的 caregiver 关系。使用斯坦福综合移植评估（SIPAT）评估治疗准备情况。使用 χ 检验比较根据 caregiver 关系的评估结果。多变量逻辑回归确定了 caregiver 与根据性别和种族的资格之间的关联。
女性和黑人患者不太可能将配偶作为他们的支持人（P<.001）。女性不太可能被认为有资格接受先进的治疗（调整后的优势比[aOR].64，95%置信区间[CI].46-.89；P=.008），黑人女性比白人女性的资格更低（aOR.28，95%CI.11-.72；P=.008）。社会支持和 SIPAT 评分在性别或种族方面没有显著影响资格。
缺乏 caregiver 的支持被认为是先进治疗的相对禁忌症。我们队列中 caregiver 的类型根据种族和性别而有所不同，但不能解释先进治疗资格的差异。
