Transforming Advanced Heart Failure Programs: Addressing Institutional and Systemic Drivers of Racial and Ethnic Disparities in Care

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  Figure 1.. Race- and sex-based differences in heart failure (HF) mortality and allocation of advanced therapies. HF is common and among those who progress to advanced HF, only a small proportion receive advanced therapies. There are race- and sex-based disparities in allocation of advanced therapies, with lower implantation and transplantation rates among Black Americans despite higher risk of mortality. Numerical data were sourced from HF Stats 2025. J Card Fail. 20251 and tabulated from Organ Procurement & Transplantation Network National Data (https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/). Age-adjusted HF mortality rates are for those aged ≥25 years. LVAD indicates left ventricular assist device.

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  Figure 2.. Historical policies and events with negative impacts on population health. A, Relevant policies that in combination may contribute to heart failure (HF). B, Example, of associations between a single policy and development of HF. Throughout history there have been several policies, events, and judgments that have created, sustained, or exacerbated differential access to healthy environments and communities, educational and economic opportunities, and quality health care. The long-standing and intergenerational impacts of these historical trends have been linked to disparate health outcomes among those with limited economic resources and the racial and ethnic groups impacted. The accumulation of these events has both direct and indirect impacts on the access to care and outcomes for patients with HF. Diligence is needed to examine the health impacts of current and new policies to avoid the perpetuation of current disparities and promote healthier populations. Additional details about the information listed can be found at:…

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  Figure 3.. Structural barriers to advanced heart failure (HF) care. Barriers to equitable access and outcomes at the provider-, institutional- (HF program), community-, and policy-levels are indicated to highlight opportunities for investigation and action for HF programs, state and local leaders, and policymakers.

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  Figure 4.. Implementation and dissemination goals to improve access and outcomes in advanced heart failure (HF). These evidence-based strategies and best practices need to be systematically disseminated and implemented across Heart Failure Programs to optimize advanced HF care for all. SDOH indicates social drivers of health.