Racial Disparities Seen in Heart Transplant Patients with COVID-19

Black men who have received heart transplants may be at increased risk for worse outcomes with COVID-19, indicating gender and racial disparities that warrant further research, according to a study published in the Journal of Cardiac Failure.

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Researchers noted that patients with orthotopic heart transplantation (OHT) represent a population that may have an atypical presentation of COVID-19 symptoms or have a higher risk for adverse outcomes from COVID-19.

The Michigan Medicine Frankel Cardiovascular Center team identified 13 patients who had a previous heart transplant and were admitted to one of two hospitals in southeast Michigan for COVID-19 symptoms. Researchers examined patients’ demographic data, clinical history, laboratory and radiologic results, and therapies administered. All patients observed were black males.

All patients had at least 15 days of follow-up. Of the 13 admitted patients, researchers found that two had died, two remain hospitalized in acute care, and nine had been discharged from the hospital.

Researchers noted that although these patients presented with symptoms typical of most individuals with COVID-19, the observed patients suffered poorer or more severe outcomes.

“Despite immunosuppression, the clinical presentation and laboratory markers of disease severity showed similarities to what has been observed in the general population,” said first author Scott Ketcham, MD, an internal medicine resident physician.

“However, almost half were critically ill and there was a higher rate of mortality than described among non-heart transplant recipients admitted with COVID-19.”

The group pointed out that because all observed patients were black males, these results should lead to further investigation. Across the country, minority and underserved communities have been disproportionately impacted by COVID-19 and have suffered poorer outcomes from the virus.

Recent studies have pointed to a lack of quality care access in these populations as a main contributor to disparities in COVID-19 outcomes. A team from Sutter Health found that despite having health insurance, black patients with COVID-19 may not seek testing and care until it is an emergency situation, revealing major gaps in care delivery.

“The COVID-19 pandemic has ripped a Band-Aid off of the structural inequities that exist within our society – we must address these disparities right away because the cost of not addressing them is measured in human life,” said Stephen Lockhart, MD, PhD, chief medical officer at Sutter Health. 

“With lives on the line, we as a state can and should do better in connecting minority patients to culturally competent care.  We have a moral obligation to do so and must work together to meet this moment and lean into the opportunity to advance health equity for generations to come.”

The Michigan Medicine researchers acknowledged that similar disparities have been observed in their own state as well. While just 14 percent of the population in Michigan is black, 33 percent of COVID-19 cases and 41 percent of deaths occurred in the black community. However, the group also noted that genetic makeup could play a role in the observed trends.

“Racial disparities in COVID-19 outcomes have been observed in several states. Although this imbalance is potentially due to the prevalence of comorbid conditions or health care disparities, genetic polymorphisms in the renin-angiotensin system may also contribute to this risk,” the researchers said.

“Previous reports have identified alterations in the renin-angiotensin system activity profile of blacks. Severe acute respiratory syndrome coronavirus enters human cells through angiotensin-converting enzyme receptors and angiotensin II activity potentially contributes to disease severity and organ damage.”

The study was limited in that it only considered a very small group of COVID-19 patients who had received heart transplants, researchers stated.

“Owing to the small sample size of this case series, no definitive conclusions can be drawn regarding COVID-19 susceptibility in black males with OHT. We also cannot make any conclusions regarding COVID-19-specific treatments or the management of immunosuppression in this setting,” the team noted.

“As such, further research is needed to determine if disease severity and COVID-19 risk is greater in black males with OHT and whether patient characteristics or treatments specific to OHT can be modified to decrease this risk.”

The results from this study indicate potential gaps in COVID-19 care, and warrant future investigation into the underlying reasons for poorer outcomes among this group of patients.

“Further research should focus on racial and gender disparities in COVID-19 and on the identification of prognostic markers, treatments, and appropriate immunosuppression modifications for patients with OHT with COVID-19,” researchers concluded.