Sutter Health CPMC Center for Advanced Heart Failure Therapies, California Pacific Medical Center, San Francisco, California.
MedStar Heart and Vascular Institute, Advanced Heart Failure Program, Georgetown University, Washington, District of Columbia.
Am J Cardiol. 2022 Dec 15;185:46-52. doi: 10.1016/j.amjcard.2022.09.015. Epub 2022 Oct 22.
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.
晚期心力衰竭（HF）治疗可改善 D 期 HF 患者的生存率。我们试图通过多中心调查评估晚期 HF 治疗转诊和决策中种族/民族和性别的差异。我们对美国 9 个中心的 515 例接受晚期 HF 治疗评估的患者进行了回顾性分析。中位年龄为 58 岁，73%为男性。白人患者占转诊患者的 55.7%，而非白人患者占 44.3%。非缺血性病因在非白人患者中更为常见（66.6%比 47.4%，p=0.0005），而男性中缺血性病因更为常见（37.8%比 20.4%，p=0.0005）。转诊的主要原因因种族/民族而异，但不因性别而异，白人患者中室性心律失常（7.6%比 3%，p=0.024）和肺动脉高压（3.4%比 0.4%，p=0.018）更为常见，而心力衰竭恶化的情况较少见（25.4%比 35.9%；p=0.009）。白人患者比非白人患者更常接受左心室辅助装置（LVAD）（60.3%比 54.7%，p=0.039）和心脏移植（51.8%比 33.1%，p=0.0007）。非白人患者更不愿意接受 LVAD 治疗（17.6%比 9.6%；p=0.049）。由于精神社会禁忌，男性更常因心脏移植被拒绝（34%比 15%，p=0.005）。总之，在这项针对晚期 HF 治疗转诊的多中心分析中，我们观察到种族、民族和性别在转诊特征和评估结果方面存在显著差异。需要进一步研究以更好地理解为什么接受晚期治疗转诊的非白人患者的 LVAD 和移植率可能较低。
