Is Equity Being Traded for Access to Heart Transplant?

Disparities in care and outcomes are common, complex problems and are well illustrated by heart failure, from the initial diagnosis to the treatment of advanced disease. In the US, Black individuals develop heart failure at a much younger age than individuals of other races, and the incidence for Black individuals is 50% higher than that for White individuals. Although the age-adjusted hospitalization rate for Black patients with heart failure in the US has decreased over the past 20 years, it was still approximately 2.2 times the rate for White patients in 2018. There is also a concern for disparities in unrecognized heart failure among Black patients and among female patients, as they are more likely to be diagnosed in the acute care setting despite having symptoms for months before diagnosis. The increased risk extends to those with end-stage heart failure, with Black patients accounting for 26.5% of hospitalizations coded as end-stage heart failure (2017-2020), which is double their 12.1% share of the overall US population in the 2020 US census.