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Black patients with HF less likely to be seen by cardiologist in ICU
Among those admitted to the ICU with HF, black patients were less likely to be seen by cardiologists than white patients, researchers reported.
Being seen by a cardiologist was associated with improved odds of in-hospital survival for both races, according to the researchers.
“Both patients and physicians should know that racial disparities exist in health care. Patients must be their own advocates and not fear getting a second opinion, especially when they believe they are not being heard,” Khadijah Breathett, MD, MS, assistant professor of medicine in the division of cardiology at the University of Arizona College of Medicine – Tucson, said in a press release. “Physicians should adhere to guideline recommendations, advocate for underserved populations and be aware of implicit biases that may adversely affect clinical management. Bias in clinical decision-making has contributed to disparate treatment in racial and ethnic minorities. We must consider that it may be present.”
Breathett and colleagues analyzed 104,835 patients (20% black; mean age, 71 years; 51% men) from the Premier database who were admitted to the ICU with HF between 2010 and 2014. The outcomes of interest were being seen by a cardiologist and in-hospital survival.
Compared with black patients, white patients had greater odds of being cared for by a cardiologist (adjusted OR = 1.42; 95% CI, 1.34-1.51), according to the researchers.
Primary ICU care by a cardiologist was associated with a better chance of in-hospital survival than primary ICU care by a non-cardiologist (aHR = 1.2; 95% CI, 1.11-1.28), Breathett and colleagues wrote. This relationship did not significantly vary by race (P for interaction = .32).
“Racial and ethnic disparities in health care delivery remain a persistent systematic problem, and drastic steps are needed to reduce the racial/ethnic and gender health disparities that persist in contemporary care,” Breathett said in the release. “We could consider rewarding centers that reduce disparities in their respective centers, use innovative techniques to reduce disparities and provide high quality care. We could also consider penalizing centers that provide poor quality care. It is time to change the operations of the U.S. health care system.”
“Is it not time to consider preconceived notions of access and inherent, although unrecognized, racial bias and stereotyping that lead to racial health disparities?” Cardiology Today Editorial Board Member Ileana L. Piña, MD, MPH, wrote in a related editorial.
“The team approach using guideline-driven quality care is imperative in the ICU setting,
where the patients have a high level of illness,” she wrote. “Breathett et al demonstrated that patients with HF benefited from cardiology care applying guideline-directed medical and device therapy, and there was a modest impact on access to care. More data are needed to reduce disparities in care optimally.” – by Erik Swain
Disclosures: Breathett and Piña report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.