Are Black patients not getting LVADs as quickly as white patients?

Researchers from the University of Missouri conducted a study that found disparities in treating Black and white patients with advanced heart failure.

According to a news release, the study found that Black patients with advanced heart failure were more likely to receive a left ventricular assist device (LVAD) — a pump implanted into the chest to help blood flow throughout the body — later in their disease progression when compared to white patients, ultimately resulting in worse health outcomes.

MU School of Health Professions associate professor Adrianne Frech and fellow co-authors of the study analyzed data from the United Network for Organ Sharing (UNOS) that covered patients who received an LVAD as a temporary “bridge” solution to their heart failure while on a waiting list to receive a permanent heart transplant between 1999 and 2014.

Frech and the researchers found no racial inequality in terms of access alone to the devices, but they uncovered that underlying factors contributed to Black patients being less likely to receive a heart transplant when compared to white patients.

“If you just look at that one piece of the puzzle, we found there was no significant difference for Black and white patients in accessing these devices as the technology improved over time,” Frech said in the release. “But as I dug deeper, where the inequalities emerged was when they got the device, as Black patients were more likely to be sicker by the time they received the LVAD compared to white patients, making them more likely to be deemed ineligible for a heart transplant and taken off the waiting list.”

The release also noted a positive step with regard to this issue, as CMS announced that individuals would be reimbursed for LVADs, even if they are not yet sick enough to receive a heart transplant. Frech believes the policy change will benefit all individuals on Medicare and Medicaid, while Black patients are more likely to be on public insurance programs than white patients, according to the release.

Preventive care remains at the forefront of producing better health outcomes, though, and the research from Missouri highlights how inequality can persist in healthcare systems and result in worsened outcomes for some.

“The process UNOS uses for determining who gets a heart transplant has many algorithms attached to it, so it is meant to be a completely fair process, but inequality is so pervasive in society that it still happens even without anyone intentionally trying to be racist or classist,” Frech said. “The goal of the research is to articulate the more nuanced places where inequality happens so that we can identify and target those areas to help reduce those inequalities.”

When asked if it had observed racial inequalities in this area, Abbott, a major player in the LVAD space, offered a comment through a spokesperson:

“As part of our purpose to help people live fuller lives through better health, Abbott is committed to advancing health equity, working side-by-side with the communities we serve to address health disparities and tackle barriers to health. Access to innovative heart failure therapy is critical to slowing the progression of this challenging condition. As a leader in health care, we partner with physicians and organizations to improve access to the latest medical treatments to benefit the health of more people, in more places than ever before. Looking ahead, advancing health equity is a key focus for our business and our partnerships with others, including advancing care for diseases that have an outsized impact on communities of color.”