A systematic review of the relationship between race and health-related quality of life outcomes in patients with advanced heart failure who undergo heart transplantation or mechanical circulatory support

PURPOSE: Health inequalities may disproportionately affect health-related quality of life (HRQOL) in patients with heart failure who identify as a racial or ethnic minority and undergo advanced surgical therapies. Objectives of this systematic review were to determine the impact of race on HRQOL of adults who undergo heart transplantation (HT) or durable mechanical circulatory support (MCS), while awaiting HT or long-term, and whether race is a risk factor for worse HRQOL. METHODS: A synthesis framework was used following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Medical Subject Headings was applied to search engines. Peer reviewed articles (English) published prior to 1/5/25, examining associations between race & HRQOL of adults who underwent HT and/or MCS, were included. Excluded were systematic reviews, editorials/opinions, case series/reports, grey literature, qualitative research, and case-control studies. Risk of bias was assessed using Joanna Briggs Institute checklists and the Cochrane Risk-of-Bias tool. RESULTS: Among 2,902 identified records, eight studies met inclusion criteria (HT: n = 4; MCS: n = 3; and HT and MCS: n = 1). Participants' mean age = 57 years; the majority were White (80%) and male (78%). Risk of bias varied by study. Race did not impact HRQOL in 50% of HT studies. HRQOL improved with MCS in all studies; however, compared to White patients, Black patients experienced less improvement in HRQOL. CONCLUSIONS: HRQOL measures were not comparable. Thus, a meta-analysis was not performed which is a study limitation. Racial differences in HRQOL may exist among adults who undergo HT and/or MCS; more research is needed.