Does Failure to Rescue Drive Race/Ethnicity-based Disparities in Survival After Heart Transplantation?

OBJECTIVE: The objective was to assess whether race/ethnicity is an independent predictor of failure to rescue (FTR) after orthotopic heart transplantation (OHT). SUMMARY BACKGROUND DATA: Outcomes following OHT vary by patient level factors; for example, non-White patients have worse outcomes than White patients after OHT. Failure to rescue is an important factor associated with cardiac surgery outcomes, but its relationship to demographic factors is unknown. METHODS: Using the United Network for Organ Sharing database, we included all adult patients who underwent primary isolated OHT between 1/1/2006 snd 6/30/2021. FTR was defined as the inability to prevent mortality after at least one of the UNOS-designated postoperative complications. Donor, recipient, and transplant characteristics, including complications and FTR, were compared across race/ethnicity. Logistic regression models were created to identify factors associated with complications and FTR. Kaplan Meier and adjusted Cox proportional hazards models evaluated the association between race/ethnicity and posttransplant survival. RESULTS: There were 33,244 adult, isolated heart transplant recipients included: the distribution of race/ethnicity was 66% (n=21,937) White, 21.2% (7,062) Black, 8.3% (2,768) Hispanic, and 3.3% (1,096) Asian. The frequency of complications and FTR differed significantly by race/ethnicity. After adjustment, Hispanic recipients were more likely to experience FTR than White recipients (OR 1.327, 95% CI[1.075-1.639], P =0.02). Black recipients had lower 5-year survival compared with other races/ethnicities (HR 1.276, 95% CI[1.207-1.348], P <0.0001). CONCLUSIONS: In the US, Black recipients have an increased risk of mortality after OHT compared with White recipients, without associated differences in FTR. In contrast, Hispanic recipients have an increased likelihood of FTR, but no significant mortality difference compared with White recipients. These findings highlight the need for tailored approaches to addressing race/ethnicity-based health inequities in the practice of heart transplantation.

Patterns of referral for refugees in western Tanzania: a retrospective review.

Introduction: access to essential secondary and tertiary healthcare, including surgery and medical sub-specialties, is a challenge in low-and-middle income countries (LMICs), especially for displaced populations. Referrals from refugee camps are highly regulated and may pose barriers to accessing essential secondary healthcare in a timely manner. Refugee referral systems and the ways they interact with national systems are poorly understood. Such information is necessary for resource allocation and prioritization, optimizing patient outcomes, national-level planning, and investment in capacity-building. Methods: a retrospective review of referrals from Nyarugusu Refugee Camp in Tanzania to Kabanga Hospital between January 2016-May 2017 was conducted. Data was collected from logbooks on patient demographics, diagnosis, and reason for referral. Diagnoses and reasons for referral were further coded by organ system and specific referral codes, respectively. Results: there were 751 entries in the referral logbook between January 2016 and May 2017. Of these, 79 (10.5%) were excluded as they were caretakers or missing both diagnoses and reason for referral resulting in 672 (89.5%) total entries for analysis.The most common organ system of diagnosis was musculoskeletal (171, 25.5%) followed by head, ear, eye, nose and throat (n=164, 24.4%) and infectious disease (n=92, 13.7%). The most common reason for referral was imaging (n=250, 37.2%) followed by need for a specialist (n=214, 31.9%) and further management (n=116, 17.3%). X-ray comprised the majority of imaging referred (n=249, 99.6%). The most common specialties referred to were ophthalmology (n=104, 48.6%) followed by surgery (n=63, 29.4%), and otolaryngology (ENT) (n=17, 7.9%). Conclusion: given a large burden of referral for refugee patients and sharing of in and out-of-camp healthcare facilities with nationals, refugees should be included in national health care plans and have clear referral processes. Epidemiological data that include these intertwined referral patterns are necessary to promote efficient resource allocation, reduce unnecessary referrals, and prevent delays in care that could affect patient outcomes. International agencies, NGOs, and governments should conduct cost analyses to explore innovative capacity-building projects for secondary care in camp-based facilities.

Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.

Protracted conflicts in the Middle East have led to successive waves of refugees crossing borders. Chronic, non-communicable diseases are now recognised as diseases that need to be addressed in such crises. Cancer, in particular, with its costly, multidisciplinary care, poses considerable financial and ethical challenges for policy makers. In 2014 and with funding from the United Nations High Commissioner for Refugees, we reported on cancer cases among Iraqi refugees in Jordan (2010-12) and Syria (2009-11). In this Policy Review, we provide data on 733 refugees referred to the United Nations High Commissioner for Refugees in Lebanon (2015-17) and Jordan (2016-17), analysed by cancer type, demographic risk factors, treatment coverage status, and cost. Results show the need for increased funding and evidence-based standard operating procedures across countries to ensure that patients have equitable access to care. We recommend a holistic response to humanitarian crises that includes education, screening, treatment, and palliative care for refugees and nationals and prioritises breast cancer and childhood cancers.