Hospitals with high proportions of Black patients provide similar HF care vs. other centers
Click Here to Manage Email Alerts
Key takeaways:
- Quality of heart failure care was no different at hospitals with high proportions of Black patients vs. other hospitals.
- Quality of care was similar across races at high-proportion Black hospitals.
Heart failure quality-of-care did not differ between hospitals with high proportions of Black patients vs. other hospitals and researchers reported no significant differences in care by race.
This analysis of the American Heart Association’s Get with the Guidelines-HF registry was published in JAMA Cardiology.
“Using the AHA’s Get with the Guidelines-HF registry, we compared quality of care for HF at hospitals caring for high proportions of Black patients to other hospitals in the United States. Quality of care was similar across 11 of 14 measures at hospitals with high proportions of Black patients compared with other hospitals,” Rishi K. Wadhera, MD, MPP, MPhil, section head of health policy and equity at the Richard A. and Susan F. Smith Center for Outcomes Research, associate program director of cardiovascular medicine fellowship at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, told Healio. “However high-proportion Black hospitals performed worse on three measures: discharge with a follow-up visit made for within 7 days, receiving cardiac resynchronization device placement or prescription and use of aldosterone antagonists.
“Defect-free HF care did not differ between these hospitals, and importantly, there was no evidence of within-hospital Black-white disparities for this composite measure of quality,” he said. “In the subset of Medicare patients, risk-adjusted 30-day mortality was similar and 30-day readmissions higher at hospitals with proportions of Black adults compared with other hospitals.”
Wadhera and colleagues used the AHA’s ongoing, voluntary quality-improvement based, Get with the Guidelines-HF registry to identify differences in quality of HF care at 96 hospitals with high proportions of Black patients compared with other hospitals. The analysis included 422,483 patients (mean age, 73 years; 53% men; 67.4% white).
The primary outcome was quality of HF care as assessed using 14 evidence-based measures, defect-free care and 30-day readmission and mortality among patients with Medicare insurance.
HF care similar between hospital groups
Wadhera and colleagues reported that quality of HF care was similar between hospitals with high proportions of Black patients compared with other hospitals for 11 of the Get with the Guidelines-HF registry measures, including:
- use of ACE inhibitors, angiotensin receptor blockers and angiotensin receptor/neprilysin inhibitors (ARNIs; adjusted OR = 0.91; 95% CI, 0.65-1.27);
- use of beta-blockers (aOR = 1.02; 95% CI, 0.82-1.28);
- use of ARNIs at discharge (aOR = 0.74; 95% CI, 0.54-1.02);
- anticoagulation for atrial fibrillation/flutter (aOR = 1.05; 95% CI, 0.76-1.45); and
- ICD counseling, placement and prescription at discharge (aOR = 0.75; 95% CI, 0.5-1.13).
However, compared with other hospitals, patients who received treatment at high-proportion Black hospitals were less likely to be discharged with a follow-up visit made within 7 days (OR = 0.68; 95% CI, 0.53-0.86), to receive cardiac resynchronization device placement and/or prescription (OR = 0.63; 95% CI, 0.42-0.95) or to receive an aldosterone antagonist (OR = 0.69; 95% CI, 0.5-0.97), according to the study.
Overall, defect-free HF care was similar between both groups of hospitals (high-proportion Black hospitals, 82.6%; other hospitals, 83.4%; OR = 0.89; 95% CI, 0.67-1.19) and researchers observed no significant differences in HF care quality among Black patients compared with white patients.
Thirty-day readmissions was higher among Medicare beneficiaries treated at high-proportion Black hospitals compared with other hospitals (HR = 1.14; 95% CI, 1.02-1.26), yet 30-day mortality was not significantly different between the two hospital groups (HR = 0.92; 95% CI, 0.84-1.02), according to the study.
Racial inequities in HF mortality ‘staggering’
“It’s also important to remember that although our study included 480 hospitals — and more than 420,000 HF hospitalizations — from across the U.S., all hospitals had voluntarily elected to participate in the GWTG-HF quality improvements registry, and so gaps in quality may be more common and larger at nonparticipating hospitals that were not included in our study,” Wadhera told Healio.
“The inequities in HF mortality between Black and white adults in the U.S. are staggering, and our study provides suggestive evidence that these population-level disparities may not be due to large gaps in measurable quality of care within hospital walls,” he said. “These findings highlight the need for public health and policy initiatives that directly target upstream factors, including structural inequities in access to primary and preventive care, suboptimal rates of treatment and control of CV risk factors and social determinants of health that contribute to high HF mortality rates among Black adults.”
For more information:
Rishi K. Wadhera, MD, MPP, MPhil, can be reached at rwadhera@bidmc.harvard.edu.
Collapse
Click Here to Manage Email Alerts