دورية أكاديمية
Emerging Racial Differences in Heart Transplant Waitlist Outcomes for Patients on Temporary Mechanical Circulatory Support.
| العنوان: | Emerging Racial Differences in Heart Transplant Waitlist Outcomes for Patients on Temporary Mechanical Circulatory Support. |
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| المؤلفون: | Rekhtman D; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Iyengar A; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Song C; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Weingarten N; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Shin M; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Patel M; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Herbst DA; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Helmers M; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Cevasco M; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Atluri P; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: pavan.atluri@pennmedicine.upenn.edu. |
| المصدر: | The American journal of cardiology [Am J Cardiol] 2023 Oct 01; Vol. 204, pp. 234-241. Date of Electronic Publication: 2023 Aug 07. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Excerpta Medica Country of Publication: United States NLM ID: 0207277 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1913 (Electronic) Linking ISSN: 00029149 NLM ISO Abbreviation: Am J Cardiol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Excerpta Medica |
| مواضيع طبية MeSH: | Heart Transplantation* , Extracorporeal Membrane Oxygenation* , Heart-Assist Devices* , Heart Failure*/surgery, Adult ; Humans ; Male ; Race Factors ; Treatment Outcome ; Risk Factors ; Waiting Lists ; Retrospective Studies |
| مستخلص: | Temporary mechanical circulatory support (tMCS) is increasingly used for patients awaiting heart transplantation. Although examples of systemic inequity in cardiac care have been described, biases in tMCS use are not well characterized. This study explores the racial disparities in tMCS use and waitlist outcomes. The United Network for Organ Sharing database was used to identify adults listed for first-time heart transplantation from 2015 to 2021. White and non-White patients on extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary left ventricular assist device were identified. Waitlist outcomes of mortality, transplantation, and delisting were analyzed by race using competing risks regression. The effect of the new heart allocation system was also assessed. A total of 16,811 patients were included in this study, with 10,377 self-identifying as White and 6,434 as non-White. White patients were more often male, privately ensured, and had less co-morbidities (p <0.05). tMCS use was found to be significantly higher in non-White patients (p <0.001). Among those on tMCS, non-White patients were more likely to be delisted because of illness (subhazard ratio 1.34 [1.09 to 1.63]) and less likely to die while on the waitlist (subhazard ratio 0.76 [0.61 to 0.93]). This disparity was not present before the implementation of the new heart allocation system. tMCS use was proportional to the risk factors identified in the non-White cohort. After the implementation of the new heart allocation system, White patients were more likely to die, whereas non-White patients were more likely to be delisted. Further work is needed to determine the causes of and potential solutions for disparities in the waitlist outcomes. Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare. (Copyright © 2023 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Heart Transplantation; New Allocation System; Racial Disparities; Waitlist Outcomes; temporary mechanical circulatory support |
| تواريخ الأحداث: | Date Created: 20230809 Date Completed: 20230904 Latest Revision: 20230905 |
| رمز التحديث: | 20240829 |
| DOI: | 10.1016/j.amjcard.2023.07.086 |
| PMID: | 37556892 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1879-1913 |
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| DOI: | 10.1016/j.amjcard.2023.07.086 |