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Disparity in the Setting of Incident Heart Failure Diagnosis
Quick Takes
- This retrospective analysis of a nationally representative claims database reports that a large proportion of new HF diagnoses occurred in an acute care setting.
- Furthermore, patients with female sex, Black race, and low net worth had higher acute care HF diagnosis rates suggestive of major disparities in acute care diagnosis rates.
- Timely diagnosis in the outpatient setting may permit high-value interventions started earlier, reduce HF progression, and address the identified disparities.
Study Questions:
What is the frequency of heart failure (HF) diagnosis in the acute care setting versus the outpatient setting in a database of privately insured and Medicare Advantage patients?
Methods:
The investigators estimated the proportion of incident HF diagnosed in the acute care setting (inpatient hospital or emergency department) versus outpatient setting based on diagnostic codes from a claims database covering commercial insurance and Medicare Advantage between 2003 and 2019. After excluding new-onset HF potentially caused by a concurrent acute cause (e.g., acute myocardial infarction), they identified demographic, clinical, and socioeconomic predictors of diagnosis setting. Patients were linked to their primary care clinicians to evaluate diagnosis setting variation across clinicians. The authors estimated the association between patient characteristics and acute care diagnosis using a multivariable logistic regression model with adjustment for all characteristics.
Results:
Of 959,438 patients with new HF, 38% were diagnosed in acute care. Of these, 46% had potential HF symptoms in the prior 6 months. Over time, the relative odds of acute care diagnosis increased by 3.2% annually after adjustment for patient characteristics (95% confidence interval [CI], 3.1%-3.3%). Acute care diagnosis setting was more likely for women compared with men (adjusted odds ratio, 1.11 [95% CI, 1.10-1.12]) and for Black patients compared with White patients (adjusted odds ratio, 1.18 [95% CI, 1.16-1.19]). The proportion of acute care diagnosis varied substantially (interquartile range, 24%-39%) among clinicians after adjusting for patient-level risk factors.
Conclusions:
The authors concluded that earlier diagnosis could allow for timelier high-value interventions, address disparities and reduce the progression of HF.
Perspective:
This retrospective analysis of a nationally representative claims database reports that a large proportion of new HF diagnoses occurred in an acute care setting. Furthermore, patients with female sex, Black race, and low net worth had higher acute care HF diagnosis rates suggestive of major disparities in acute care diagnosis rates. These acute care diagnoses may represent missed opportunities for earlier intervention given nearly half had possible HF symptoms in the 6 months before diagnosis. Timely diagnosis in the outpatient setting may permit high-value interventions started earlier, reduce heart failure progression, and address the identified disparities.
Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure
Keywords: Critical Care, Diagnosis, Disease Progression, Emergency Service, Hospital, Healthcare Disparities, Heart Failure, Inpatients, Medicare Part C, Myocardial Infarction, Outpatients, Primary Prevention, Primary Health Care, Risk Factors, Socioeconomic Factors
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