According to an upcoming article in “Current Opinions in Cardiology,” race and sex have a significant impact on in-hospital admissions and overall outcomes in patients with acute decompensated heart failure (ADHF) and cardiogenic shock. Black patients have a higher incidence of heart failure, higher admissions for ADHF, and worse overall survival than other racial groups. At the same time, women receive fewer interventions for cardiogenic shock, complicating acute myocardial infarction. Moreover, White patients are more likely than Black patients to be cared for by a cardiologist in the ICU, which results in better overall survival. Recent data outline inherent racial and sex bias in the evaluation process for advanced heart failure therapies indicating that the Black race negatively impacts referral rates for transplant. Women are judged more harshly on their appearance, and Black women are perceived to have less social support than other races. This implicit bias in the evaluation process may impact the appropriate referral for advanced heart failure therapies.