Poor, minority heart transplant patients fare worse

NEW YORK (Reuters Health) - Lower-income and minority heart transplant recipients may have a poorer long-term outlook than white or more-affluent patients, a new study suggests.

In a study of 520 adults and children who received heart transplants at one of four Boston centers between 1996 and 2005, researchers found that those from the most disadvantaged neighborhoods were more likely to die or need a new transplant over the next five years.

The researchers gauged the patients' socioeconomic status by looking at their neighborhoods' typical income and education levels, home values and occupations.

They found that of the one-quarter of patients from the most disadvantaged neighborhoods, 35 percent died or received a new heart over five years. That figure was 25 percent among the rest of the study group.

When the researchers examined risk factors for transplant failure, socioeconomics and race and ethnicity were each linked to patients' outcomes.

Minority heart recipients -- most of whom were black or Hispanic -- were 70 percent more likely than whites to die or need another new heart during the study period. Patients from the lowest socioeconomic group had a 50 percent higher risk than the rest of the study patients.

The findings, published in the American Journal of Cardiology, suggest that factors like income and race influence heart transplant success. But they do not explain why, according to the researchers, led by Dr. Tajinder P. Singh of Children's Hospital Boston.

All of the patients had insurance, Singh told Reuters Health in an email, and the type of insurance -- private or public -- was not related to their long-term prognosis.

"Because it does not appear to be an access issue," he said, "and there is no difference in outcomes based on type of insurance, some unmeasured factors related to socioeconomic position are affecting the outcomes."

Those factors, Singh speculated, might include patients' knowledge of their medical condition, including knowing when to seek help from their doctors.

Minority patients and those from disadvantaged neighborhoods generally had more episodes of organ rejection - in which the immune system launches a response against the donor heart. Those higher rates, the researchers say, may help explain the higher long-term risks of death and repeat transplants.

Although all donor-heart recipients go on immune-suppressing drugs to prevent rejection, many patients still develop signs of rejection at some point and may need changes in their medication. So it is important that patients be aware of the potential signs and symptoms of rejection -- including shortness of breath, fatigue and weight gain from fluid retention.

Singh said the current findings help raise awareness that racial and income gaps in heart transplant success exist. The next step, he said, is to weed out the reasons so that they can be addressed.

SOURCE: American Journal of Cardiology, online February 16, 2010.