Racial Disparities in Clinical and Cost Outcomes Among Heart Transplant and Left Ventricular Assist Device Recipients: A Systematic Review

TL;DR

This study finds racial disparities in access to heart transplants and LVADs, as well as in mortality and costs, emphasizing the need for equitable healthcare solutions.

Contribution

The paper systematically reviews racial disparities in heart transplant and LVAD access, mortality, and costs using data from 20 studies and over 785,000 patients.

Findings

White patients received the majority of heart transplants and LVADs compared to other racial groups.

Asian patients had the highest in-hospital mortality rate among all racial groups.

Cost outcomes varied by race, with Asian patients having the highest mean cost and Black patients the lowest.

Abstract

Although racial disparities in cardiac interventions have been studied extensively, disparities in heart transplants (HTs) and left ventricular assist devices (LVADs) have not been well-established. A systematic review was undertaken wherein 20 studies were identified for investigation, with a total of 785,486 patients. Of these, 104,356 patients were studied to assess HT and LVAD access, 332,885 patients were studied to assess in-hospital mortality rate, 346,303 patients were studied to assess organ function, and 1,942 patients were studied to assess costs associated with HT or LVAD treatment among different racial groups. Access was evaluated via the percentage of patient race within each study's population. White patients received the majority of LVADs (44,248 patients, 63.34%) and HTs (21,273 patients, 61.67%), followed by Black patients for LVADs (16,437 patients, 23.53%) and HTs (7,603 patients, 22.04%). Hispanic/Latino patients had the lowest rates of LVADs (4,071 patients, 5.83%) and HTs (3,153 patients, 9.14%). Asian patients had the highest in-hospital mortality (4,104 patients, 39.2%), whereas White patients had the lowest (84,977 patients, 36.2%). Results of cost outcomes varied, with Asian patients having the highest mean cost and Black patients having the lowest mean cost for transplantation. Racial disparities in HTs and LVADs were noted, highlighting the need for multi-faceted approaches to provide equitable access and improved outcomes.

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