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Background: Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. Results: Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84–0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72–0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. Conclusions: Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

This article makes the case for a new and ambitious research and governance agenda for energy demand reduction. It argues that existing 'demand-side' approaches focused on promoting technological efficiency and informed individual consumption are unlikely to be adequate to achieving future carbon emissions reduction goals; it points out that very little attention has so far been paid to the impacts of non-energy policies on energy demand; and it submits that a much fuller integration of energy demand questions into policy is required. It advances a general framework, supported by illustrative examples, for understanding the impacts of 'non-energy' policies on energy demand. It reflects on why these connections have been so little explored and addressed within energy research and policy. And it argues that, for all their current 'invisibility', there is nonetheless scope for increasing the visibility of, and in effect 'mainstreaming', energy demand reduction objectives within other policy Department for Business Energy and Industrial Strategy (2018a) Smart meters: a guide.

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