In an ethnically diverse nationwide registry of patients with heart failure (HF) receiving care in a universal health system, non-White patients, compared with White patients, were more likely to receive HF specialist care, be discharged on guideline-directed medical therapy (GDMT) and have a better prognosis, regardless of HF type, age, sex, place of residence or socioeconomic status, according to research published March 17 in JACC.

The study, conducted in the United Kingdom using national registry data, grouped 239,890 patients hospitalized for HF by self-reported ethnicity: 215,800 were White, 6,610 Black, 12,940 Asian and 4,540 mixed/other. White patients were older at a median 81 years compared with 75 for non-White patients. Women comprised about half of each group.

Overall, patients had a median of three comorbidities, with Asians having the most. In all ethnic groups, around 50% of patients had HF with reduced ejection fraction (HFrEF) – and of note, White patients were least likely to be discharged on GDMT.

Results over a median follow-up of 68 weeks found that more White patients than non-White patients died: 57% of White patients, 43% of Black patients, 48% of Asian patients and 42% of mixed/other ethnicity patients. After adjustment for age, sex, socioeconomic factors and HF severity, the risk of death remained lower in non-White patients compared with White patients, by 19% for Black patients, 23% for Asian patients and 28% for mixed/other.

Non-White patients were more likely to receive in-hospital HF specialist care and GDMT – two potential factors in the outcome disparity, according to study authors Antonio Cannata, MD, and colleagues. "These findings underscore the importance of receiving appropriate HF specialist care while hospitalized for HF," they write. "Indeed, receiving HF specialist care, regardless of ethnicity, may partially explain our results, highlighting the importance of access to care and medical treatment for patients with HF."

In an accompanying editorial comment, Riccardo M. Inciardi, MD, PhD, et al., note the striking difference in outcomes compared to studies based in the U.S. and other nonuniversal health systems. "The UK system offers a contrasting model," they write. "Universal access to medications eliminates out-of-pocket cost barriers that disproportionately disadvantage minority communities in nonuniversal systems."

"Ultimately, the findings of this analysis provide a compelling argument that disparities in HF are not inevitable," they conclude. "When evidence-based therapies are universally affordable and specialist care is readily accessible, the prognostic disadvantage experienced by minority groups can be substantially attenuated and, in some settings, reversed. Health systems that prioritize affordability, specialist pathways, and engagement of deprived communities are central to advancing an equity paradigm in HF care."