Race, Quality of Care, and Outcomes of Elderly Patients Hospitalized With Heart Failure

Abstract

EART FAILURE IS A NATIONAL epidemic, affecting nearly 5 million persons in the United States, with an additional 550 000 diagnosed each year. 1 This burden is disproportionately borne by black Americans, who have a higher incidence and prevalence of heart failure than members of other racial groups. 1 Despite this greater burden, black patients may receive less intensive and poorer-quality care for heart failure than whites. 2-5 Some studies, however, suggest that black patients receive similar quality of care as members of other racial groups. 6-10 Because prior studies evaluated patients treated in selected centers or regions 6-10 and assessed treatment or utilization patterns and not objective measures of quality of care, 3,9,10 it is unclear if reported racial differences reflect shortfalls in care or appropriate treatment or are representative of current national practice patterns. A national evaluation of racial patterns of heart failure care is timely given the

Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure

“…Consistent with previous research, black women in our study received a diagnosis of HF at younger ages and were more likely to have comorbidities, limitations in activities of daily living, and a lack of health insurance compared with white women 1, 7, 9, 17, 18, 49. However, racial differences in hospitalization largely remained despite adjustments for these and other risk factors.…”

“…Instead, we found that black‐white differences in the number of hospitalizations were most pronounced in the Northeast and West. It is not clear whether or to what extent these differences may be related to possible regional variations in the quality of HF care 17, 55. We encourage additional studies to further validate these findings of patient‐level changes in hospitalizations following an HF diagnosis.…”

“…Racial and ethnic disparities in HF have been well documented5, 6, 7, 8 and a number of recent studies have shown that older black and Hispanic adults are hospitalized and readmitted more frequently for this condition than whites 9, 10, 11, 12, 13, 14. The reasons for these differences are largely unknown and racial/ethnic disparities largely persist after accounting for a variety of measures for the patients' background and clinical care 15, 16, 17, 18…”

“…Much of the existing literature on racial/ethnic differences in HF hospitalization has been based on hospital discharge records and administrative claims data from Medicare beneficiaries 4, 10, 12, 13, 16, 17, 19. Moreover, studies have not examined the number and timing of hospitalizations over the course of the disease, which may be crucial to planning the immediate and long‐term delivery of care in patients with HF.…”

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

“…The availability of genetic ancestry can help differentiate true inherited differences versus the wide range of environmental factors that are associated with self‐identified race, such as socioeconomic status, diet, and healthcare quality and accessibility, all of which can make attempts to understand the underlying cause of race disparities in health outcomes very difficult 37. It is important to interrogate the role of genetic ancestry because socioeconomic factors do not fully explain the critical race disparities in HF outcomes,38 and to try to quantify potential genetic and biological effects. For example, African genetic ancestry is associated with poorer diastolic function parameters in HF patients 39.…”