Abstract 4137107: The Impact of Race in the Evaluation Process for Advanced Heart Failure Therapies

Introduction: Racial and socioeconomic disparities in heart failure therapy and heart transplantation have been well described. Potential racial disparities during the evaluation process for advanced heart failure (AHF) therapies is not well understood. We examined whether there were differences by race in the evaluation process for heart transplantation or left ventricular assist device (LVAD) implantation. Methods: Adult patients who underwent heart transplant or LVAD evaluation between May 1, 2014 – Dec 31, 2022 at the University of North Carolina Medical Center were included. Logistic regression models assessed whether approval for heart transplant listing or LVAD implantation differed by race. The multivariate model adjusted for demographic and clinical characteristics, LVEF, RV function, and substance use. Secondary outcomes assessed included the time between critical points in the evaluation process: first clinical encounter with an AHF specialist, evaluation initiation, and final decision. Results: The study cohort included 611 patients (304 non-Hispanic Black patients, 307 non-Hispanic White patients). Black patients were younger than White patients (52.4 vs. 60.7 years), less male-predominant (65.5% vs. 81.4%), with less ischemic cardiomyopathy (16.8% vs. 58.3%, all p<0.05). There was no significant difference in approval for advanced therapies between Black and White patients (unadjusted OR [95% CI]: 1.24 [0.90-1.72]; adjusted OR 0.98 [0.64-1.48]). Male sex was associated with a higher likelihood of approval for AHF therapies (adjusted OR 1.55 [1.02-2.36]). Age (OR 0.98 [0.96-0.99]) and creatinine (OR 0.66 [0.53-0.82]) were associated with a lower likelihood of approval for AHF therapies. Black patients had a significantly longer time interval from the first AHF specialist encounter to the initiation of evaluation for AHF therapies (median 45.5 vs. 14 days, p <0.01), and from the initiation of the evaluation process to the final decision (25.5 vs. 14 days, p <0.01). Conclusions: Male patients had a greater approval rate for advanced heart failure therapies. Black and white patients did not have significantly different approval rates for LVAD implantation or listing for heart transplantation. However, the evaluation process was longer for black patients. Further work is needed to investigate which factors contribute to these racial and sex differences in the evaluation and approval process for advanced heart failure therapies.