Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic Group
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Author
Breathett, K.Yee, R.
Pool, N.
Thomas, Hebdon, M.C.
Knapp, S.M.
Herrera-Theut, K.
de Groot, E.
Yee, E.
Allen, L.A.
Hasan, A.
Lindenfeld, J.
Calhoun, E.
Carnes, M.
Sweitzer, N.K.
Affiliation
School of Medicine, University of ArizonaIssue Date
2023-02-27Keywords
group decision-makinggroup think
heart failure
heart transplantation
racial disparities
ventricular assist device
women’s health
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American Heart Association Inc.Citation
Breathett, K., Yee, R., Pool, N., Thomas Hebdon, M. C., Knapp, S. M., Herrera‐Theut, K., ... & Sweitzer, N. K. (2023). Group dynamics and allocation of advanced heart failure therapies—heart transplants and ventricular assist devices—by gender, racial, and ethnic group. Journal of the American Heart Association, 12(5), e027701.Rights
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License.Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.Abstract
BACKGROUND: US regulatory framework for advanced heart failure therapies (AHFT), ventricular assist devices, and heart transplants, delegate eligibility decisions to multidisciplinary groups at the center level. The subjective nature of decision-making is at risk for racial, ethnic, and gender bias. We sought to determine how group dynamics impact allocation decision-making by patient gender, racial, and ethnic group. METHODS AND RESULTS: We performed a mixed-methods study among 4 AHFT centers. For ≈ 1 month, AHFT meetings were audio recorded. Meeting transcripts were evaluated for group function scores using de Groot Critically Reflective Diagnoses protocol (metrics: challenging groupthink, critical opinion sharing, openness to mistakes, asking/giving feedback, and experi-mentation; scoring: 1 to 4 [high to low quality]). The relationship between summed group function scores and AHFT allocation was assessed via hierarchical logistic regression with patients nested within meetings nested within centers, and interaction effects of group function score with gender and race, adjusting for patient age and comorbidities. Among 87 patients (24% women, 66% White race) evaluated for AHFT, 57% of women, 38% of men, 44% of White race, and 40% of patients of color were allocated to AHFT. The interaction between group function score and allocation by patient gender was statistically significant (P=0.035); as group function scores improved, the probability of AHFT allocation increased for women and decreased for men, a pattern that was similar irrespective of racial and ethnic groups. CONCLUSIONS: Women evaluated for AHFT were more likely to receive AHFT when group decision-making processes were of higher quality. Further investigation is needed to promote routine high-quality group decision-making and reduce known disparities in AHFT allocation. © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.Note
Open access journalISSN
2047-9980PubMed ID
36846988Version
Final Published Versionae974a485f413a2113503eed53cd6c53
10.1161/JAHA.122.027701
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Except where otherwise noted, this item's license is described as © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License.
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