Race and baseline severity of heart failure in the registry evaluation for vital information on VADs in ambulatory life (REVIVAL)
Lanfear DE, Forde-McLean R, Haas D, Robinson S, Thibodeau J, Teuteberg J, Jorde U, Khalatbari S, Spino C, Jeffries N, Stevenson L, Mann D, Stewart G, Aaronson K. Race and baseline severity of heart failure in the registry evaluation for vital information on VADs in ambulatory life (REVIVAL). J Heart Lung Transplant. 2018;37(4):S189.
Purpose: African Americans (AA) with heart failure (HF) suffer disproportionately poor outcomes compared to white counterparts. Whether delays of care influence this is unclear. We aimed to assess whether AA patients assessed in advanced HF clinics were more symptomatic or higher risk compared to white patients. Methods: REVIVAL is a prospective cohort study enrolling 400 patients at 21 VAD/transplant centers in the U.S. during 2015-2016. Patients had NYHA class II-IV, EF < 35% despite optimal medical therapy and either a recent HF hospitalization, transplant listing, functional limitation, or evidence of neurohormonal activation. Exclusions were inotropes, dialysis, creatinine ≥ 3mg/dL or a non-cardiac disease limiting function or survival. Symptom severity, Seattle Heart Failure Model (SHFM) score, functional assessments, and quality of life instruments were collected at baseline. We compared selfidentified AA (n= 101) to white (n= 281) patients using Wilcoxon rank sumtest (median and interquartile range shown), and multivariate models adjusted for age and sex. Results: AA patients were younger and more often female (Table). In univariable analyses NYHA class, baseline dyspnea, fatigue, INTERMACS profile, 6 minute walk distance (6MWD), PHQ8 score, Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score, and MAGGIC score were similar between groups (all p> 0.1). In AA, five meter gait speed was slower (4.3 [1.8] vs. 4.1 [1.4] seconds, p= 0.046) but post-6MWD dyspnea was less (10  vs. 11 , p= 0.01) and SHFM score lower (p= 0.001; SHFM-predicted 1y survival 95% vs. 93%) compared to whites. In adjusted analyses the KCCQ (p= 0.046) and SHFM score (p= 0.02) were better in AA patients. Conclusion: Among patients with advanced HF seen at VAD/transplant centers in the U.S., AA patients have broadly similar risk and symptom profiles compared to white patients, suggesting delay in referral to specialized centers is not a key factor contributing to disparities (Table presented).