Racial and Ethnic Differences in Heart Failure Outcomes

Study Questions:

Are there racial and ethnic differences in outcomes after heart failure (HF) hospitalization in patients with similar access to care?

Methods:

The study authors performed a retrospective study evaluating the impact of race and ethnicity on outcomes in 8,532 HF hospitalizations at 11 hospitals in New York City from 2007 to 2010. They evaluated 30- and 90-day readmission and 30-day and 1-year mortality rates. They utilized generalized estimating equations for associations between ethnicity and race and outcomes. They adjusted for covariates, including demographics, utilization/access variables, insurance status, socioeconomic status, clinical variables, and comorbid conditions, and included a fixed-effect for the hospital to which the patient presented.

Results:

The study authors found that 51% of patients were black (n = 4,305), 29% Hispanics (n = 2,449), 18% whites (n = 1,494), and 3% were Asians (n = 284). They found that Asians and blacks had lower 1-year mortality compared with whites (1-year mortality rates were 31% for whites, 20% for blacks, 24% for Hispanics, and 16% for Asians; p < 0.0001) with adjusted odds ratios (aORs) of 0.75 (95% confidence interval [CI], 0.59-0.94) and 0.57 (95% CI, 0.38-0.85), respectively, whereas rates for Hispanics were not significantly different (aOR, 0.81; 95% CI, 0.64-1.03). Hispanics had higher odds of readmission than whites (aOR, 1.27; 95% CI, 1.03-1.57) at 30 (aOR, 1.40; 95% CI, 1.15-1.70) and 90 days.

Conclusions:

The authors concluded that access to health care, by itself, may not be adequate to ameliorate racial and ethnic disparities in HF outcomes.

Perspective:

This study supports earlier data that access to health care by itself is not adequate to ameliorate racial and ethnic disparities in clinical care. The differences in pathophysiology of HF in different ethnic groups require that clinicians tailor therapy accordingly. Another approach to eliminate disparities is to increase awareness about unconscious biases in management of medical care. The first step would be to evaluate one’s own tendency for bias by doing the Implicit Association Test at https://implicit.harvard.edu/implicit/takeatest.html. Moreover, this paper should prompt further investigation on eliminating racial and ethnic disparities in HF outcomes.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: African Americans, Asian Americans, Ethnic Groups, Health Services Accessibility, Heart Failure, Hispanic Americans, Insurance Coverage, Outcome Assessment (Health Care), Patient Readmission, Social Class


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