Abstract 4362734: Racial and Ethnic disparities in heart transplantation and in-hospital mortality in patients admitted with end-stage heart failure (ESHF) in 2021: A Nationwide Analysis

Abstract

Background: Heart transplant is considered the gold standard for the management of end-stage heart failure. Black patients have historically been known to have a higher mortality risk following cardiac transplantation. Objective: This paper aims to evaluate the latest findings in the racial distribution of heart transplantation and any associated predictors of in-hospital mortality. Methods: Data from the National Inpatient Sample (NIS) database from 2021 was used to identify adults with ESHF. Four racial groups were identified: White, Black, Hispanic, and Asian. Univariate and multivariate regression analysis was used to ascertain the unadjusted and adjusted odds of heart transplantation and in-hospital mortality across various racial groups. Results: In 2021, 6,807 patients with ESHF were admitted, with 3,454 receiving heart transplants (51%, p = 0.039). Most of these patients were male (68%, p<0.001) and were covered by Medicare (63%, p<0.001). Overall, in-hospital mortality for ESHF patients was 13% (p<0.001). Comorbidities such as hypertension, coronary artery disease, and CKD were higher in ESHF patients (p<0.001, all). Predominantly, 62% of heart transplant recipients were White, 27% were Black, 8% were Hispanic, and 3% were Asian. (P=0.039). Compared to Whites, Blacks and Hispanics had lower mortality rates (OR: 0.59; 95% CI: 0.49-0.71) and (OR: 0.71; 95% CI: 0.53-0.95), respectively. Mortality rates between Whites and Asians were comparable. However, when adjusted for age, sex, household income, smoking, coronary artery disease, hypertension, hyperlipidemia, cerebrovascular disease, Diabetes, old MI, CKD, heart transplant, and regional location, Blacks had a lower mortality rate compared to Whites (AOR: 0.75; 95% CI:0.61-0.91). No difference in mortality was found in Hispanics and Asians. Heart transplant in ESHF was associated with a lower in-hospital mortality rate. (HR:0.68; 95% CI: 0.59-0.77). Across all races, transplant was associated with overall improved in-hospital survival. (log-rank p<0.0001). Conclusion: Heart transplant in ESHF was associated with a lower in-hospital mortality rate than in patients who did not receive heart transplants. Transplant rates continue to be lower in Blacks compared to Whites. However, Blacks experienced lower in-hospital mortality compared to other races, even after adjusting for age, sex, and other comorbidities. Additional studies are needed to confirm these findings.