The finding that Arab Israeli’s have a higher incidence of CAV than Jewish Israelis is intriguing and potentially highlights the critical role statins have in cardiac transplant patients. Moreover, it exposes the possibility of a selection bias occurring during cardiac transplant listing decisions. Making sure that all patients suitable for cardiac transplant, regardless of ethnicity and socioeconomic status are actually referred is notoriously difficult. Avoiding bias during patient selection requires being religiously consistent when evaluating relevant information regarding potential transplant candidates. We continue to work on this at our institutions by using specific and consistent selection criteria and a diverse cardiac transplant team.
We commend the authors for examining a sensitive issue in their country and for having the courage to publish their results. We would be delighted to see them continue to study the reasons for differing outcomes amongst Jewish and Arab Israelis and then advocate for measures that would improve outcomes for all Israelis suffering from advanced heart failure.