Health care providers may perpetuate racial disparities in the treatment of heart failure

Black adults are believed to have an increased risk of heart failure, underscoring the need for equitable treatment and decision-making.

A study supported by the National Institutes of Health (NIH) found that black individuals had a 55% lower rate of heart transplantation (VAD therapy), which may be due to implicit bias, according to the researchers.

“An immediate step could be to require implicit bias training, especially for transplant and VAD team members,” said Dr. Wendy S. Taddei-Peters, study author and Clinical Trials Project Officer in the Division of Cardiology. -vascular sciences at the National Heart Center, Lung and Blood Institute (NHLBI), in a news release.

Previous research has identified differences between race and the treatment of advanced heart failure, noting that black adults with end-stage heart failure are more likely to die from it. This study extends these previous studies in the Registry Evaluation of Vital Information for VADs in Ambulatory Life (REVIVAL) study.

REVIVAL is a 2-year observational study looking at possible relationships between heart failure treatment, disease severity, quality of life, and social determinants of health (environmental factors that influence health outcomes). The researchers identified 377 adult patients treated for heart failure.

The data suggested that 22% of white adults were treated with a VAD, which mechanically pumps blood to the heart. Among black adults, 11% were treated with therapies for end-stage heart failure; however, no associations between race and mortality were observed.

“The body of evidence suggests that we as heart failure providers are perpetuating the current disparities,” said first study author Thomas M. Cassino, MD, clinical instructor in the Division of Cardiovascular Disease at the University of Michigan in Ann Arbor, in press release.

The study data also show that patient treatment preferences do not lead to inequality, but rather that inequality may be due to unconscious bias — possibly intentional acts of racism and discrimination — on behalf of health care providers, according to the study’s authors .

“Recognizing differences is not enough. As physicians and health care providers, we must find ways to create equitable change,” Cassino said in the press release.

Health care providers are encouraged to understand inherent biases. These data have also led researchers to suggest standardizing advanced heart failure therapy and partnering with “disparity experts” because they can provide learning opportunities and promote equity, according to Taddei-Peters, as well as identify solutions that can be influenced by unconscious biases.

According to the Centers for Disease Control and Prevention, more than 6.2 million people in the United States are estimated to have heart failure. Symptoms may include shortness of breath, swelling of the lower body – especially in the feet and ankles, and fatigue.

Diabetes is also a risk factor for heart failure. In the context of this study, it is noteworthy that diabetes may disproportionately affect adults who are black, American Indian, Alaska Native, and Hispanic.

“The lives disabled or lost are simply too many,” Thaddeus-Peters said in the press release. “Disparity experts can identify these biases and barriers in real time, provide learning opportunities and promote equity.”


NIH/National Heart, Lung, and Blood Institute. NIH-supported study finds racial disparities in treatment of advanced heart failure. EurekAlert. October 19, 2022. Accessed October 19, 2022.

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