# Impact of Disparities Affecting Survival among Advanced Heart Failure Patients and Transplant Recipients

> **NIH NIH R01** · CLEVELAND CLINIC LERNER COM-CWRU · 2020 · $779,535

## Abstract

DESCRIPTION: The current heart transplant allocation system and the newly recommended one
prioritizes patients based on waitlist survival and does not take into account risk of death after transplant or
likelihood of transplantation. Furthermore, it defines medical urgency for transplantation mainly by use of devices
and not by objective evidence of medical illness. Unfortunately, many heart failure patients die on the waitlist,
including a disproportionate number of women, Hispanics, and patients with certain heart diseases like restrictive
cardiomyopathy. After transplantation there are also survival disparities. The long-term goal of this project is to
optimize timing for advanced heart failure therapy in order to improve survival and minimize organ wastage. The
objective of this research application is to identify risk factors for disparities in survival among heart transplant
candidates and post-transplantation and to create tools that will improve outcome in therapy while minimizing
organ wastage. The central hypothesis is that a better heart transplant allocation system requires knowledge of
how population differences affect patient selection, waitlist mortality, and post-transplant mortality. The rationale
for the proposed research is that there are known disparities (sex, race, and type of heart disease) in survival
among advanced heart failure patients (pre- and post-transplantation) and creation of risk prediction models
have successfully reduced waitlist mortality for lung, liver, and kidney transplantation. The specific aims of this
research proposal are: 1) to identify risk factors for disparities in survival among heart transplant candidates and
post-transplantation using the national transplant database 2) to develop a method to dynamically update risk of
waitlist mortality across time using data from multiple transplant centers that includes potential prognistic risk
factors not available in our national transplant database and 3) to create a mathematical model that simultaneous
estimates waitlist and post-transplant mortality to optimize timing of transplantation. The approach is innovative
because it utilizes new mathematical approaches and seeks to shift current heart failure research and clinical
practice paradigms by taking into account population differences rather than basing decisions solely on ejection
fraction, presence of coronary artery disease, and stages of disease. The proposed research is significant,
because few studies have explored population differences in advanced heart failure to determine the factors
associated with mortality on the waitlist and poor outcome post-transplantation. This proposal will evaluate the
complex interplay of population differences (i.e sex, race, type of heart disease, laboratory measures of organ
dysfunction, and influences of co-morbidities) as they relate to mortality on the waitlist, timing of transplantation,
and mortality after transplantation. If the aims of our proposal are a...

## Key facts

- **NIH application ID:** 9884783
- **Project number:** 5R01HL141892-03
- **Recipient organization:** CLEVELAND CLINIC LERNER COM-CWRU
- **Principal Investigator:** Eileen Michelle Hsich
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $779,535
- **Award type:** 5
- **Project period:** 2018-04-01 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9884783

## Citation

> US National Institutes of Health, RePORTER application 9884783, Impact of Disparities Affecting Survival among Advanced Heart Failure Patients and Transplant Recipients (5R01HL141892-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9884783. Licensed CC0.

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