Persistent Racial Disparities in Survival After Heart Transplantation

Liu, Vincent; Bhattacharya, Jay; Weill, David; Hlatky, Mark A.

doi:10.1161/circulationaha.110.976811

Cited by 68 publications

(61 citation statements)

References 42 publications

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“…3,6,18 We found that most of the socioeconomic and immunologic risk factors associated with GF were more common in blacks and Hispanics. Immunologic risk factors carried the highest risk of GF in all race/ethnic groups; however, immunologic factors played a larger role in the development of GF in blacks and Hispanics.…”

Section: Discussionmentioning

confidence: 79%

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation

Morris

Καλογερόπουλος

Zhao

et al. 2015

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 79%

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation

Morris

Καλογερόπουλος

Zhao

et al. 2015

The Journal of Heart and Lung Transplantation

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“…We have therefore chosen to review a broad range of articles pertinent to racial and ethnic disparities in cardiovascular disease. These include papers examining racial differences in the quality of care provided for patients with myocardial infarction, 11 trends in procedure use for patients with heart failure, 12 survival after heart transplantation, 13 the relative importance of traditional and novel biomarkers of cardiovascular risk, 14 and the influence of socioeconomic factors such as living environment on outcomes. 6 We hope you find these reviews informative.…”

mentioning

confidence: 99%

Most Important Articles on Cardiovascular Disease Among Racial and Ethnic Minorities

Mody¹,

Gupta²,

Bikdeli³

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research in the area of cardiovascular disease among racial and ethnic minorities. (Circ Cardiovasc Quality and Outcomes. 2012; 5:e33-e41.) S teady improvements have been made in the management of cardiovascular disease over the last decade.1,2 Yet, certain racial and ethnic minority groups have not experienced equivalent improvements in outcomes. For example, although the overall rate of hospitalization for heart failure has declined in recent years, decreases have been lower in blacks compared with whites. 2In addition, mortality related to stroke continues to be higher in blacks.3 There are multiple potential explanations for this heightened cardiovascular risk among minorities, including their higher prevalence of cardiovascular risk factors such as hypertension, diabetes mellitus, and obesity 4 ; the presence of genetic differences predisposing to disease 5 ; differences in socioeconomic factors relating to education, income, language proficiency, and living environments 6 ; and concerning physician attitudes, biases, or frank racism. 3,7 The Institute of Medicine defines "disparities" as "differences in health outcomes that persist when access and patient clinical factors are controlled." 8 In acknowledging the presence of these disparities experienced by racial and ethnic minorities, the American College of Cardiology (ACC) launched the Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes (CREDO) alliance and the American Heart Association (AHA) issued a statement highlighting racial differences in stroke care, among other initiatives.9,10 Through these efforts, the ACC and AHA aim to improve physician awareness of racial disparities in cardiovascular disease care, conduct patient education, and provide tools to health systems to help combat inequalities.There is an urgent need for additional information regarding the pathways mediating racial disparities in cardiovascular care, especially those pathways that are amenable to interventions. We have therefore chosen to review a broad range of articles pertinent to racial and ethnic disparities in cardiovascular disease. These include papers examining racial differences in the quality of care provided for patients with myocardial infarction, 11 trends in procedure use for patients with heart failure, 12 survival after heart transplantation, 13 the relative importance of traditional and novel biomarkers of cardiovascular risk, 14 and the influence of socioeconomic factors such as living environment on outcomes. 6 We ...

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“…Several studies have assessed racial differences in longterm survival among HT recipients and have attributed a higher rate of graft loss in black recipients to immune-related mechanisms. [11][12][13] This is the first study to focus on racial/ ethnic differences in wait-list outcomes. The findings were somewhat unexpected in light of previous observations from several unrelated sources.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][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.…”

Section: Clinical Perspective On P 3030mentioning

confidence: 99%

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

Singh

Almond²,

Taylor³

et al. 2012

Circulation

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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...

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Persistent Racial Disparities in Survival After Heart Transplantation

Cited by 68 publications

References 42 publications

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation

Most Important Articles on Cardiovascular Disease Among Racial and Ethnic Minorities

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

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