Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction
Background The extent to which sex, racial, and ethnic groups receive advanced heart therapies equitably is unclear. We estimated the population rate of left ventricular assist device (LVAD) and heart transplant (HT) use among (non‐Hispanic) White, Hispanic, and (non‐Hispanic) Black men and women wh...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031021 |
| _version_ | 1797296280182980608 |
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| author | Scott W. Rose Braden W. Strackman Olivia N. Gilbert Karen E. Lasser Michael K. Paasche‐Orlow Meng‐Yun Lin Georgia Saylor Amresh D. Hanchate |
| author_facet | Scott W. Rose Braden W. Strackman Olivia N. Gilbert Karen E. Lasser Michael K. Paasche‐Orlow Meng‐Yun Lin Georgia Saylor Amresh D. Hanchate |
| author_sort | Scott W. Rose |
| collection | DOAJ |
| description | Background The extent to which sex, racial, and ethnic groups receive advanced heart therapies equitably is unclear. We estimated the population rate of left ventricular assist device (LVAD) and heart transplant (HT) use among (non‐Hispanic) White, Hispanic, and (non‐Hispanic) Black men and women who have heart failure with reduced ejection fraction (HFrEF). Methods and Results We used a retrospective cohort design combining counts of LVAD and HT procedures from 19 state inpatient discharge databases from 2010 to 2018 with counts of adults with HFrEF. Our primary outcome measures were the number of LVAD and HT procedures per 1000 adults with HFrEF. The main exposures were sex, race, ethnicity, and age. We used Poisson regression models to estimate procedure rates adjusted for differences in age, sex, race, and ethnicity. In 2018, the estimated population of adults aged 35 to 84 years with HFrEF was 69 736, of whom 44% were women. Among men, the LVAD rate was 45.6, and the HT rate was 26.9. Relative to men, LVAD and HT rates were 72% and 62% lower among women (P<0.001). Relative to White men, LVAD and HT rates were 25% and 46% lower (P<0.001) among Black men. Among Hispanic men and women and Black women, LVAD and HT rates were similar (P>0.05) or higher (P<0.01) than among their White counterparts. Conclusions Among adults with HFrEF, the use of LVAD and HT is lower among women and Black men. Health systems and policymakers should identify and ameliorate sources of sex and racial inequities. |
| first_indexed | 2024-03-07T22:02:20Z |
| format | Article |
| id | doaj.art-84458a5abe574172904bc384034d1ef8 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T22:02:20Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-84458a5abe574172904bc384034d1ef82024-02-24T04:04:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-01-0113210.1161/JAHA.123.031021Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection FractionScott W. Rose0Braden W. Strackman1Olivia N. Gilbert2Karen E. Lasser3Michael K. Paasche‐Orlow4Meng‐Yun Lin5Georgia Saylor6Amresh D. Hanchate7Section of Cardiology Medicine, Department of Medicine Wake Forest University School of Medicine Winston‐Salem NC USADepartment of Social Sciences and Health Policy, Division of Public Health Sciences Wake Forest University School of Medicine Winston‐Salem NC USASection of Cardiology Medicine, Department of Medicine Wake Forest University School of Medicine Winston‐Salem NC USASection of General Internal Medicine Boston University School of Medicine Boston MA USADepartment of Medicine Tufts University School of Medicine and Tufts Medical Center Boston MA USADepartment of Social Sciences and Health Policy, Division of Public Health Sciences Wake Forest University School of Medicine Winston‐Salem NC USASection of Cardiology Medicine, Department of Medicine Wake Forest University School of Medicine Winston‐Salem NC USADepartment of Social Sciences and Health Policy, Division of Public Health Sciences Wake Forest University School of Medicine Winston‐Salem NC USABackground The extent to which sex, racial, and ethnic groups receive advanced heart therapies equitably is unclear. We estimated the population rate of left ventricular assist device (LVAD) and heart transplant (HT) use among (non‐Hispanic) White, Hispanic, and (non‐Hispanic) Black men and women who have heart failure with reduced ejection fraction (HFrEF). Methods and Results We used a retrospective cohort design combining counts of LVAD and HT procedures from 19 state inpatient discharge databases from 2010 to 2018 with counts of adults with HFrEF. Our primary outcome measures were the number of LVAD and HT procedures per 1000 adults with HFrEF. The main exposures were sex, race, ethnicity, and age. We used Poisson regression models to estimate procedure rates adjusted for differences in age, sex, race, and ethnicity. In 2018, the estimated population of adults aged 35 to 84 years with HFrEF was 69 736, of whom 44% were women. Among men, the LVAD rate was 45.6, and the HT rate was 26.9. Relative to men, LVAD and HT rates were 72% and 62% lower among women (P<0.001). Relative to White men, LVAD and HT rates were 25% and 46% lower (P<0.001) among Black men. Among Hispanic men and women and Black women, LVAD and HT rates were similar (P>0.05) or higher (P<0.01) than among their White counterparts. Conclusions Among adults with HFrEF, the use of LVAD and HT is lower among women and Black men. Health systems and policymakers should identify and ameliorate sources of sex and racial inequities.https://www.ahajournals.org/doi/10.1161/JAHA.123.031021ethnicityheart failureheart transplantleft ventricular assist deviceracereduced ejection fraction |
| spellingShingle | Scott W. Rose Braden W. Strackman Olivia N. Gilbert Karen E. Lasser Michael K. Paasche‐Orlow Meng‐Yun Lin Georgia Saylor Amresh D. Hanchate Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ethnicity heart failure heart transplant left ventricular assist device race reduced ejection fraction |
| title | Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction |
| title_full | Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction |
| title_fullStr | Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction |
| title_full_unstemmed | Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction |
| title_short | Disparities by Sex, Race, and Ethnicity in Use of Left Ventricular Assist Devices and Heart Transplants Among Patients With Heart Failure With Reduced Ejection Fraction |
| title_sort | disparities by sex race and ethnicity in use of left ventricular assist devices and heart transplants among patients with heart failure with reduced ejection fraction |
| topic | ethnicity heart failure heart transplant left ventricular assist device race reduced ejection fraction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031021 |
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