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Given the same clinical history, hypothetical heart failure patients were viewed differently by clinicians depending on gender and race, though recommended therapy was largely similar, researchers found in a study.

Clinicians were randomized to one of four vignettes varying only by gender and race: a white woman, an African American woman, a white man, and an African American man. They were instructed to discuss their thoughts on that patient with advanced disease and multiple relative contraindications for advanced heart therapies and were given photographs, text, and the name of that person.

Talking through how they would allocate therapy during the study interviews, study participants expressed several gender and racial biases, according to investigators led by Khadijah Breathett, MD, MS, of Sarver Heart Center at University of Arizona in Tucson, reporting :

• Harsher criticism of the appearance of women than that of men
• Perception that the African American man had more severe illness than others
• More concern regarding appropriateness of prior care of the African American woman compared with the white woman
• Greater concerns about adequacy of social support for women, especially the African American woman

"Ultimately, VADs [ventricular assist devices] were recommended over transplantation for patients irrespective of patient race and gender during the interviews and no significant differences were observed in treatment recommendations with surveys, but differences were found between vignettes that might negatively affect the ," Breathett's group concluded.

In particular, racial and gender bias may contribute to delayed allocation of advanced heart failure therapies for certain groups, the authors suggested.

Bias training and small systemic changes may improve equity in heart failure advanced therapies, they said. "Participants in this study identified patient photographs and descriptions of children as potential sources of bias. Steps can be taken to avoid including these data during routine presentations of candidates for advanced therapies."

"Sex/gender and race bias in evaluation and assessment for cardiovascular disease has been a longstanding issue in medicine. Women are less likely to undergo heart transplantation compared with men and are 20% more likely to die waiting for a heart transplant compared with men," commented Bessie Young, MD, MPH, of Veterans Affairs Puget Sound Health Care System in Seattle.

She agreed that review teams should undergo implicit bias and antiracist training as part of a "patient-centered approach to evaluation and allocation of listing for VAD and organ transplantation."

Study participants were 46 U.S. clinicians attending the International Society for Heart and Lung Transplantation conference in April 2019. Roughly half were women, and 43% racial minorities.

All underwent interviews and had their perceptions quantified on a survey. Randomization was weighted 20:3 toward analysis of the female patient vignettes.

"Potential limitations of the study included the vignettes, which presented women who were older with children and seemed slightly implausible. Also, the survey in this study appeared to be underpowered, such that no definitive conclusion could be reached regarding gender or race differences," according to Young.

Other limitations include include the small number of people analyzing the male vignettes. Some participants may also have suspected the objectives of the study and provided socially desirable results, the investigators acknowledged.

"Understanding biases that may contribute to the allocation process are important and will allow for the standardization of that process, improvement in access to advanced heart failure therapies for women and patients from minority groups, and development of interventions aimed at decreasing health disparities in the assessment process," according to Young.

In any case, having more community health workers and patient navigators may help to identify patients earlier in the disease process so that could be instituted earlier, possibly obviating the need for advanced therapies, she noted.

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