Disparate Quality of Care for Black and Hispanic Heart Failure {HF} Patients: A Report from Get with the Guidelines – Heart Failure {GWTG-HF}

Yancy, Clyde W.; Fonarow, Gregg C.; LaBresh, Kenneth A.; Albert, Nancy M.; Ellrodt, Gray; Hernandez, Adrian F.; Yu, Yanglin; Peterson, Eric D.

doi:10.1016/j.cardfail.2007.06.554

Cited by 4 publications

(5 citation statements)

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“…Data from the GWTG-HF (Get With the Guidelines-Heart Failure) program demonstrated that the percentages of Hispanic patients receiving 2 HF performance measures (discharge instructions and angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker therapy) were intermediate between African Americans and nonHispanic whites. For 2 GWTG-HF quality indicators (aldosterone antagonist therapy for LV systolic dysfunction and lipid lowering therapy), the percentages of Hispanics receiving them were higher than either subgroup (86).…”

Section: Diagnostic and Treatment Patternsmentioning

confidence: 98%

Heart Failure in Hispanics

Vivo

Krim

Çevik

et al. 2009

Journal of the American College of Cardiology

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Although large-scale heart failure (HF) studies in Hispanic Americans are lacking, some compelling data indicate that they are a particularly vulnerable population and underscore the need for further research. Hispanics comprise the largest and fastest-growing ethnic group in the U.S., in whom the impact of this burgeoning public health problem may be magnified. Current data show that Hispanics with HF are more likely to be younger and underinsured than non-Hispanic whites. They have higher rates of readmissions but have lower in-hospital and short-term mortality rates. Epidemiologic studies demonstrate that Hispanics have excessive rates of diabetes, obesity, dyslipidemia, and metabolic syndrome. Although hypertension and ischemic heart disease are established risk factors in this ethnic group, it may be considered that insulin resistance plays a significant role in the pathogenesis of HF in Hispanics, accounting for their inordinate cardiometabolic risk burden and the growing evidence of novel metabolic risk factors for HF. Hispanics encounter multiple barriers to health care influenced by socioeconomic, linguistic, and cultural factors that, in turn, have an adverse impact on disease prognosis. Recognition of predominant risk factors and health care disparities in this population is crucial to tailoring appropriate management strategies. This review summarizes epidemiologic and clinical data on Hispanics with HF, details risk factors and health care impediments, and presents an agenda for future investigation.

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Section: Diagnostic and Treatment Patternsmentioning

confidence: 98%

Heart Failure in Hispanics

Vivo

Krim

Çevik

et al. 2009

Journal of the American College of Cardiology

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“…32, 33 Data on ethnic differences in the quality of care provided for patients with HF suggest that Hispanics are less likely to receive guideline recommended care. 34-36 However, it is unlikely that providing guideline recommended care is sufficient to achieve optimal outcomes among those with low acculturation.…”

Section: Discussionmentioning

confidence: 99%

Acculturation and Outcomes Among Patients With Heart Failure

Peterson

Campagna

Maravi

et al. 2012

Circ: Heart Failure

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Background Acculturation to U.S. society among minority patients may influence health outcomes beyond race and ethnicity alone. In particular, those who are foreign-born and who do not speak English as their primary language may have greater challenges interacting with the health care system and thus be at greater risk for adverse outcomes. Methods and Results We studied patients hospitalized with a principal discharge diagnosis of HF between January 2000 and December 2007 in an integrated delivery system that cares for minority patients. Individuals were defined as having low acculturation if their primary language was not English and their country of birth was outside of the U.S. Multivariable logistic regression and Cox proportional hazards regression were used to determine the independent risk of 30-day rehospitalization and 1-year mortality, respectively. Candidate adjustment variables included demographics (age, gender, race/ethnicity), coexisting illnesses, laboratory values, left ventricular systolic function, and characteristics of the index admission. Of 1,268 patients, 30% (n=379) were Black, 39% (n=498) Hispanic, and 27% (n= 348) White. Eighteen percent (n=228) had low acculturation. After adjustment, low acculturation was associated with a higher risk of readmission at 30 days (OR 1.70; 95% CI 1.07-2.68) but not 1-year all-cause mortality (HR 0.69; 95% CI 0.42-1.14). Conclusions Patients with HF who are foreign-born and do not speak English as their primary language have a greater risk of rehospitalization, independent of clinical factors and race/ethnicity. Future studies should evaluate whether culturally concordant interventions focusing on such patients may improve outcomes for this patient population.

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“…The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE‐HF) study 9 showed that Hispanic ethnicity was an independent predictor for lack of complete discharge instructions. More recently, data from the Get With the Guidelines–Heart Failure (GWTG‐HF) program demonstrated that the percentages of Hispanic patients receiving 2 HF performance measures such as discharge instructions and ACE inhibitor or ARB therapy were intermediate between African Americans and non‐Hispanic white patients 10 . Conversely, Hispanic patients have a higher utilization in 2 GWTG‐HF quality indicators (aldosterone antagonist therapy for left ventricular systolic dysfunction and lipid‐lowering therapy) compared with persons of other ethnicities 10 …”

mentioning

confidence: 99%

“…More recently, data from the Get With the Guidelines-Heart Failure (GWTG-HF) program demonstrated that the percentages of Hispanic patients receiving 2 HF performance measures such as discharge instructions and ACE inhibitor or ARB therapy were intermediate between African Americans and non-Hispanic white patients. 10 Conversely, Hispanic patients have a higher utilization in 2 GWTG-HF quality indicators (aldosterone antagonist therapy for left ventricular systolic dysfunction and lipid-lowering therapy) compared with persons of other ethnicities. 10 Despite the limitations and more importantly the lack of clinical outcomes, the paper by Hebert and colleagues 2 in the journal is of great interest because the adherence and use of lifesaving HF therapies in a Hispanic population of patients with HF in the outpatient setting has not been studied.…”

mentioning

confidence: 99%

“…10 Conversely, Hispanic patients have a higher utilization in 2 GWTG-HF quality indicators (aldosterone antagonist therapy for left ventricular systolic dysfunction and lipid-lowering therapy) compared with persons of other ethnicities. 10 Despite the limitations and more importantly the lack of clinical outcomes, the paper by Hebert and colleagues 2 in the journal is of great interest because the adherence and use of lifesaving HF therapies in a Hispanic population of patients with HF in the outpatient setting has not been studied. This is a small step, but it is one step forward.…”

mentioning

confidence: 99%

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