Equity at the Intersection of Heart Failure and Interventions: A Review of the Spectrum From Ambulatory Care to Cardiogenic Shock

Heart failure (HF) contributes to significant morbidity, mortality, and economic burden across the United States. This burden disproportionately impacts racially and ethnically minoritized groups, women, those from socioeconomically disadvantaged backgrounds, and rural patients. Interventional HF is a burgeoning field that has the potential to transform HF health equity. As device-based and catheter-directed therapies continue to evolve and become more accessible, interventional HF possesses a promising opportunity to bridge gaps in care across 4 key domains: ambulatory remote monitoring, valvular heart disease, revascularization, and cardiogenic shock. This review aims to explore the current state of interventional HF across these domains, elucidate inequities that persist, and highlight opportunities in research and practice to improve HF outcomes for all patients. Across all 4 domains, there have been landmark advancements in therapies and procedures to improve health outcomes, yet gaps in referral and implementation of devices and procedures persist. Additionally, underrepresentation from both the race and sex perspectives continues to plague research endeavors. Intentional regulatory mandates, inclusive clinical research recruitment, and iterative implementation science are needed to enhance the opportunity of interventional HF to transform health equity in HF.