Racial and Ethnic Differences in Wait-List Outcomes in Patients Listed for Heart Transplantation in the United States

Abstract

Background-Racial differences in long-term survival after heart transplant (HT) are well known. We sought to assess racial/ethnic differences in wait-list outcomes among patients listed for HT in the United States in the current era. Methods and Results-We compared wait-list and posttransplant in-hospital mortality among white, black, and Hispanic patients Ն18 years of age listed for their primary HT in the United States between July 2006 and September 2010. Of 10 377 patients analyzed, 71% were white, 21% were black, and 8% were Hispanic. Black and Hispanic patients were more likely to be listed with higher urgency (listing status 1A/1B) in comparison with white patients (PϽ0.001).Overall, 10.5% of white, 11.6% of black, and 13.4% of Hispanic candidates died on the wait-list or became too sick for a transplant within 1 year of listing. After adjusting for baseline risk factors, Hispanic patients were at higher risk of wait-list mortality (hazard ratio 1.51, 95% CI 1.23, 1.85) in comparison with white patients, but not black patients (hazard ratio 1.13, 95% CI 0.97, 1.31). In comparison with white HT recipients, posttransplant in-hospital mortality was higher in black recipients (odds ratio 1.53, 95% CI 1.15, 2.03) but was not different in Hispanic recipients (odds ratio 0.78, 95% CI 0.48, 1.29). Conclusions-Hispanic patients listed for HT in the United States appear to be at higher risk of dying on the wait-list or becoming too sick for a transplant in comparison with white patients. Black patients are not at higher risk of wait-list mortality, but they have higher early posttransplant mortality. (Circulation. 2012;125:3022-3030.)Key Words: heart failure Ⅲ race/ethnicity Ⅲ risk factors Ⅲ survival Ⅲ transplantation E limination of racial and socioeconomic disparities in health is a national priority in the United States. 1 Racial gaps in cardiovascular care have been described in utilization of coronary revascularization and coronary artery bypass surgery, in adaptation of newer technologies such as drugeluting stents and cardiac resynchronization therapy, and in utilization of evidence-based medicines for primary and secondary prevention. 2-9 Quality-improvement initiatives to promote provider adherence with evidence-based practices have not only led to improvement in performance measures, but also to narrowing of racial gaps. 10 Clinical Perspective on p 3030Racial differences in long-term survival after heart transplant (HT) are well -known with several studies demonstrating shorter graft life in black HT recipients. 11-13 However, there is limited information regarding racial/ethnic differences in mortality among those awaiting a HT 14 and none in the current era. With a gradual change in US demographics, minorities represent a growing proportion of US population and may be expected to represent a higher percentage of HT candidates over time. 5,12 It is therefore important to know if there are racial/ethnic differences in wait-list mortality in the United States in the current era. Furthermore, because the s...

The Affordable Care Act Medicaid Expansion Correlated With Increased Heart Transplant Listings in African-Americans But Not Hispanics or Caucasians

“…(39) This could be beneficial to racial/ethnic minorities who were more likely to be listed if an inotrope was indicated in their care. (40) However guidelines for transplantation are not concrete. Conservative transplantation programs may place greater weight on insurance type when deciding which candidates should be listed for transplantation.…”

Most Important Articles on Cardiovascular Disease Among Racial and Ethnic Minorities

“…Despite constituting an increasing percentage of heart transplant candidates, racial minorities continue to be listed for transplant at a later stage in their disease process and are at higher risk for adverse outcomes in both the pre-and posttransplant phases. 42 Relative to whites, black transplant recipients have been shown to have less generous health insurance policies and lower adherence to immunosuppression, both of which are felt to contribute to poorer outcomes in this population. 43,44 Articles in this section examine multiple topics in HF including racial differences in the efficacy of β blocker therapy, trends by race in the use of implantable cardioverter defibrillators, the impact of acculturation on HF outcomes, and differences by race in the care and outcomes of heart transplantation patients.…”

Cardiac Transplantation in African Americans: A Single‐Center Experience

“…8 African Americans were much sicker at the time of transplant, with 74.3% patients in UNOS status I. Singh et al also reported similar findings in their study, in which AA and Hispanic patients were more likely to be listed with higher urgency (UNOS status I) compared with white patients (P < 0.001). 19 Despite this difference, we noted that survival among AA patients was significantly worse compared with non-AA patients within individual UNOS class.…”