Socioeconomic Disparities in Heart Transplantation
A Universal Fix?
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Heart transplantation is a definitive therapy for advanced heart failure refractory to standard medical and surgical therapy. Although over 4000 transplants are performed annually worldwide, approximately half of which are performed in the United States, this is not enough to meet the current need of those waiting.1 Selection of candidates is a comprehensive process to ensure appropriate medical necessity, absence of prohibitive contraindications, as well as adequate social and financial resources to maintain graft longevity and recipient survival.2 Socioeconomic deprivation is associated with increased incidence, earlier presentation, and worse survival in an array of cardiovascular diseases, including heart failure.3 Socioeconomic disparities have been demonstrated after heart transplant4–7; however, the impact of these disparities in a universal healthcare system is largely unknown.
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In this issue of Circulation: Cardiovascular Quality and Outcomes, Evans et al8 address this knowledge gap by assessing the impact of socioeconomic deprivation on outcomes after heart transplantation in a system of universal healthcare in England. Under the auspices of the National Health Service, universal healthcare is free to all residents with small charges for prescribed medications, though patients with long-term conditions or those living in low-income households are exempt. All patients entitled to care under the National Health Service may be referred for heart transplant evaluation regardless of socioeconomic status (SES) or ethnicity, with national consensus guidelines9 applied for patient selection. The degree of socioeconomic deprivation was assessed …