African-American patients were 40 percent less likely than Caucasian patients to be treated primarily by a cardiologist when admitted to the intensive care unit (ICU) for heart failure (HF), according to a study published April 30 in JACC: Heart Failure. Previous studies have shown that in-hospital survival is higher when patients of any race receive primary care from a cardiologist, compared to other specialties.

Khadijah Breathett, MD, MS, FACC, et al., used data from the Premier Healthcare Database, a national observational database, to analyze 104,835 patients at 497 U.S. hospitals admitted to an ICU with heart failure from 2010 to 2014. They determined race through hospital administrative data; primary care by a cardiologist was determined by billing as cardiovascular disease or cardiac electrophysiology.

Of the total cohort, 19.7 percent were African-American and 80.3 percent were Caucasian. Approximately half were male and Caucasian patients were 11 years older than African-American patients on average. The majority of patients had some form of health care insurance. African-Americans were more likely to have diabetes, chronic kidney disease, end stage renal disease or obesity while Caucasian patients had more atrial arrhythmias, chronic obstructive pulmonary disease and depression.

Results showed that Caucasians were 40 percent more likely to be admitted and receive primary care by a cardiologist compared to African-American patients. The relationship also differed by sex – Caucasian women were 30 percent more likely to be admitted by a cardiologist when compared to African-American women. The disparity was greatest for African-American men, as Caucasian men were found to be 50 percent more likely to receive care by a cardiologist than African-American men. Primary ICU care by a cardiologist led to higher in-hospital survival regardless of race.

In an accompanying editorial, Ileana L. Piña, MD, MPH, FACC, professor of medicine, Epidemiology/Population Health at Albert Einstein College of Medicine, said it is important to raise awareness for patients and providers of the racial/ethnic disparities in care, expand health insurance coverage and increase the number of providers in underserved communities.

"Given a significant percent of African-American patients either with private insurance or Medicare, can we continue to blame the disparity in care to lack of access or insurability?" Piña asked. "Is it not time to consider preconceived notions of access and inherent, although unrecognized racial bias and stereotyping that lead to racial health disparities?"

Keywords: Female, Male, Racism, Depression, Stereotyping, Atrial Fibrillation, Kidney Failure, Chronic, Heart Failure, Medicare, Obesity, Diabetes Mellitus, Pulmonary Disease, Chronic Obstructive, Primary Health Care, Intensive Care Units, Insurance Coverage

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