Study Aims to Train Advanced Heart Disease Providers to Remove Bias from Treatment Decisions

A clinical research project underway at the University of Arizona Sarver Heart Center seeks to reduce bias and remove barriers to equitable treatment for advanced heart disease through the implementation of standardized training programs for health care providers.

Studies have shown that physician bias creates disparities in advanced heart failure treatments. Standardized health care protocols can reduce the impact of implicit bias, but they have yet to be addressed for advanced heart disease therapies.

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Building on prior health disparities research that identified physician bias, Khadijah Breathett, MD, MS, FACC, FAHA, FHFSA, is leading a National Institutes of Health-funded study to launch and study the effectiveness of a training program that introduces standardized protocols to address significant barriers to equity and provide evidence-based bias training tailored for providers who specialize in advanced heart disease.

“Using an evidence-based framework for behavior change, we developed a standardized protocol strategy, Seeking Objectivity in Allocation of Advanced Heart Failure (SOCIAL HF), that addresses three significant barriers to equity in advanced therapies,” said Dr. Breathett, assistant professor of medicine in the Division of Cardiology at the UArizona College of Medicine – Tucson. The barriers include bias, subjectivity in evaluation of social support and adherence to medical advice, and poor group dynamics.

Dr. Breathett’s research team is recruiting health care teams around the U.S. who agree to work with the SOCIAL HF structure, which includes:

• evidence-based bias training tailored for heart failure treatment teams;
• employing objective evaluations of social support and adherence; and,
• environmental restructuring to ensure an equitable voice for all members of the selection team.

“Our goal is to assess real-world effectiveness and implement SOCIAL HF for the allocation of advanced heart failure therapies, such as heart transplant and ventricular-assist device implantation,” said Dr. Breathett, who is a board-certified advanced heart disease and transplant cardiologist.

To test the effectiveness of the SOCIAL HF strategy, the research team will evaluate its implementation across study sites to determine the optimal strategies to achieve equity. They also will evaluate how SOCIAL HF affects processes and outcomes important to advanced heart failure centers.

“This study proposes to implement evidence-based strategies that reduce bias, replace subjective evaluations with objective criteria, and improve group dynamics in a randomized cluster trial. Our rigorously designed trial will inform national guidelines for advanced heart failure therapy allocation,” Dr. Breathett said. “The data are likely to be generalizable to other organ replacement treatments and advanced chronic disease decision-making processes.”

This research is supported by the National Heart, Lung and Blood Institute, a division of the National Institutes of Health (1R56HL159216-01).