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No consensus exists for heart transplant listing for patients who use cannabis. We conducted a web-based survey to assess knowledge, and practice patterns towards patients with heart failure who use cannabis referred for transplant. A total of 140 clinicians (cardiologists (41.4%, n = 58), surgeons (7.1%, n = 10), pharmacists (9.3%, n = 13), advanced practice providers and coordinators) responded and responses were grouped by whether they responded that cannabis is "illegal in my state" (illegal), or "legal for medical and recreational use in my state," (legal). There was a statistically significant difference in responses between the groups in the frequency of cannabis use that should preclude a patient from HT listing p = 0.0330) with respondents where cannabis is legal tending to answer that higher frequencies were acceptable. The groups in the "legal group" responded that a validated cannabis screening questionnaire could evaluate HT eligibility (p = 0.0111). A majority in the illegal group responding "No" as to whether their program allows pre- or post-transplant patients to use prescribed cannabis products (p < 0.0001). A majority in the illegal group responding "No" while the majority in the legal group responded "Yes" to "Does your HT center's current selection criteria policy address medical cannabis use in potential transplant candidates?" (p = 0.0001). Health care providers generally agreed that a validated cannabis use disorder screening questionnaire would be useful and that 6 months of abstinence from cannabis is sufficient prior to HT listing. Significant heterogeneity exists regarding cannabis use as it relates to heart transplantation. [ABSTRACT FROM AUTHOR]

This cohort study assesses differences in donor heart acceptance by transplant center teams for Black and White men and women on the transplant waiting list in the US. Importance: Barriers to heart transplant must be overcome prior to listing. It is unclear why Black men and women remain less likely to receive a heart transplant after listing than White men and women. Objective: To evaluate whether race or gender of a heart transplant candidate (ie, patient on the transplant waiting list) is associated with the probability of a donor heart being accepted by the transplant center team with each offer. Design, Setting, and Participants: This cohort study used the United Network for Organ Sharing datasets to identify organ acceptance with each offer for US non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) adults listed for heart transplant from October 18, 2018, through March 31, 2023. Exposures: Black or White race and gender (men, women) of a heart transplant candidate. Main Outcomes and Measures: The main outcome was heart offer acceptance by the transplant center team. The number of offers to acceptance was assessed using discrete time-to-event analyses, nonparametrically (stratified by race and gender) and parametrically. The hazard probability of offer acceptance for each offer was modeled using generalized linear mixed models adjusted for candidate-, donor-, and offer-level variables. Results: Among 159 177 heart offers with 13 760 donors, there were 14 890 candidates listed for heart transplant; 30.9% were Black, 69.1% were White, 73.6% were men, and 26.4% were women. The cumulative incidence of offer acceptance was highest for White women followed by Black women, White men, and Black men (P <.001). Odds of acceptance were less for Black candidates than for White candidates for the first offer (odds ratio [OR], 0.76; 95% CI, 0.69-0.84) through the 16th offer. Odds of acceptance were higher for women than for men for the first offer (OR, 1.53; 95% CI, 1.39-1.68) through the sixth offer and were lower for the 10th through 31st offers. Conclusions and Relevance: The cumulative incidence of heart offer acceptance by a transplant center team was consistently lower for Black candidates than for White candidates of the same gender and higher for women than for men. These disparities persisted after adjusting for candidate-, donor-, and offer-level variables, possibly suggesting racial and gender bias in the decision-making process. Further investigation of site-level decision-making may reveal strategies for equitable donor heart acceptance. Key Points: Question: Is the race or gender of a patient on the heart transplant waiting list associated with the probability of a donor heart being accepted by the transplant center team with each offer? Findings: In this cohort study of 159 177 heart offers with 13 760 donors and 14 890 candidates, there was a statistically significant difference among the race and gender strata in the cumulative incidence functions, with the cumulative incidence of heart offer acceptance being consistently highest for White women followed by Black women, White men, and Black men. Meaning: The findings suggest that race and gender are significantly associated with the probability of donor heart acceptance and that investigation is needed to change modifiable factors contributing to these disparities. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E. METHODS: Using Optum's de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year. RESULTS: Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21–0.46]; P <0.001) but not Black patients (hazard ratio, 1.00 [95% CI, 0.60–1.67]; P =0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days (P <0.001) but not the remainder of the year (P =0.56). CONCLUSIONS: Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery. [ABSTRACT FROM AUTHOR]

This article is a response to questions raised about a previous study on the acceptance of donor hearts based on race and gender. The authors reexamined the data, excluding the period during the COVID-19 pandemic, and found that the disparities in acceptance of donor hearts by transplant centers based on race and gender persisted. The authors recommend further investigation into the factors that contribute to these disparities and the implementation of strategies to achieve equity in heart transplant care. [Extracted from the article]