Outcomes for HF Patients at Hospitals Caring for High Proportion of Black Adults
Quick Takes
- In a national quality improvement registry examining 422,483 hospitalizations for HF at 480 hospitals, rates of provision of 100% defect-free care for HF were no different between hospitals caring for a high proportion of Black patients vs. not.
- Hospitals caring for a high proportion of Black patients with HF had higher 30-day readmission rates with no difference in 30-day post-discharge mortality.
Study Questions:
Do hospitals caring for a high proportion of Black patients deliver lower quality of care for heart failure (HF) than other hospitals?
Methods:
The authors included all adults with a principal admission diagnosis of HF enrolled in the Get With The Guidelines’ HF (GWTG-HF) registry from 2016–2019. For each hospital, the proportion of all hospitalizations occurring in Black adults was calculated and the top quintile was classified as caring for a high proportion of Black patients. All measures of HF quality were assessed including use of guideline-directed medical therapy, smoking cessation, anticoagulation for atrial arrhythmia, venous thromboembolic prophylaxis, implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy-defibrillator (CRT-D) implant, influenza/pneumococcal vaccination, and post-discharge follow-up appointment within 7 days of discharge.
Results:
Overall, 422,483 hospitalizations for HF at 480 sites were studied. The median proportion of HF hospitalizations in Black adults was 13%, and 96 hospitals (20%) were classified as caring for a high proportion of Black patients with 58% of hospitalizations for Black adults. These hospitalizations were likely to be large teaching hospitals located in the South. After adjustment for patient and hospital characteristics, performance on 11 of 14 individual quality measures and defect-free care was no different between hospitals caring for a high versus low proportion of Black patients. However, hospitals caring for a high proportion of Black patients were less likely to use aldosterone antagonists at discharge, implant/prescribe ICD/CRT-D at discharge, and arrange for follow-up within ≤7 days. Adjusted 30-day readmission rates were higher at hospitals caring for a high proportion of Black patients with no difference in 30-day post-discharge mortality. Black patients at hospitals caring for a high proportion of Black patients had similar rates of 30-day readmissions and 30-day mortality.
Conclusions:
In a national analysis of hospitals participating in the GWTG-HF registry, provision of defect-free care was similar in hospitals caring for a high versus low proportion of Black patients. Although 30-day HF readmission rates were high, there was no difference in 30-day post-discharge mortality.
Perspective:
With implementation of federal value-based programs such as HRRP (Hospital Readmissions Reduction Program), newer data suggest that hospitals caring for a high proportion of Black patients may be disproportionately penalized, increasing racial disparities in care. Such programs do not adjust for social disadvantages and rely on claims-based measures only. In this study, in a national quality improvement registry, hospitals caring for a high proportion of Black patients were just as likely to provide 100% defect-free care as hospitals with a lower proportion of Black patients. In addition, 30-day readmissions were high without any differences in 30-day mortality, which may be driven by lower rates of post-discharge follow-up appointment within 7 days at high Black hospitals. However, these disparities are likely driven by a greater burden of social factors in communities where such hospitals are located, and these disparities are not driven by provision of lower quality of care. Accordingly, public health initiatives need to target upstream issues to break through structural inequities in health care.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and Venothromboembolism, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: African Americans, Aldosterone, Anticoagulants, Arrhythmias, Cardiac, Cardiac Resynchronization Therapy Devices, Defibrillators, Implantable, Heart Failure, Hospitalization, Outcome Assessment, Health Care, Patient Discharge, Patient Readmission, Quality Improvement, Quality of Health Care, Race Factors, Secondary Prevention, Smoking Cessation, Vaccination, Venous Thromboembolism
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