Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center.

Authors:
Haiyan Ramirez Batlle
Haiyan Ramirez Batlle
Brigham & Women's Hospital
MD
Boston, Massachusetts | United States
Lauren A Eberly Aaron Richterman Anne G Beckett Bram Wispelwey Regan H Marsh Emily C Cleveland Manchanda Cindy Y Chang Robert J Glynn Katherine C Brooks Robert Boxer Rose Kakoza Jennifer Goldsmith Joseph Loscalzo Michelle Morse Eldrin F Lewis Samantha Abel Ayrenne Adams Joseph Anaya Erik H Andrews Benjamin Atkinson Viswatej Avutu Alexandra Bachorik Omar Badri Mariel Bailey Katie Baird Salina Bakshi Denis Balaban Kenneth Barshop Emily Baumrin Omar Bayomy Julia Beamesderfer Nora Becker David D Berg Adam N Berman Steven M Blum Alexander P Boardman Kaeleen Boden Robert A Bonacci Sarah Brown Kirsti Campbell Siobhan Case Emily Cetrone Alexandra Charrow David Chiang Devin Clark Aaron J Cohen Alissa Cooper Tomas Cordova C Nicholas Cuneo Alsina Alejandro de Feria Karen Deffenbacher Ersilia M DeFilippis Geneva DeGregorio Aaron J Deutsch Bradford Diephuis Sanjay Divakaran Peter Dorschner Nicholas Downing Caitlin Drescher Kristin M D'Silva Peter Dunbar David Duong Sarah Earp Christine Eckhardt Scott A Elman Ross England Kay Everett Natalie Fedotova Tamara Feingold-Link Mark Ferreira Herrick Fisher Patricia Foo Michael Foote Idalid Franco Thomas Gilliland Jacqueline Greb Katherine Greco Sungat Grewal Benjamin Grin Matthew E Growdon Brendan Guercio Cynthia K Hahn Brian Hasselfeld Erika J Haydu Zachary Hermes Gordon Hildick-Smith Zachary Holcomb Kathryn Holroyd Laura Horton George Huang Stanley Jablonski Douglas Jacobs Nina Jain Sohan Japa Richard Joseph Mariya Kalashnikova Neil Kalwani Daniel Kang Abraar Karan Joel T Katz Daniel Kellner Khameer Kidia June-Ho Kim Scott M Knowles Laura Kolbe Idil Kore Yiannis Koullias Ifedayo Kuye Joshua Lang Matthew Lawlor Melissa G Lechner Ken Lee Scott Lee Zachary Lee Neha Limaye Stephanie Lin-Beckford Marla Lipsyc Jessica Little Julia Loewenthal Ranjani Logaraj Diana M Lopez Daniel Loriaux Yi Lu Kevin Ma Nareh Marukian Wilfredo Matias Jared R Mayers Ian McConnell Michael McLaughlin Christina Meade Catherine Meador Anish Mehta Elizabeth Messenger Constantinos Michaelidis Jacob Mirsky Emilie Mitten Alisa Mueller Jyotsna Mullur Amir Munir Emily Murphy Ellen Nagami Abirami Natarajan Michelle Nsahlai Chijioke Nze Noreen Okwara Peter Olds Rafael Paez Michael Pardo Siddharth Patel Alec Petersen Laura Phelan Erica Pimenta Daniel Pipilas Molly Plovanich Denise Pong Brian W Powers Anita Rao Mattheus Ramsis Anna Reichardt Sheridan Reiger Michelle Rengarajan Stephanie Rico Benjamin N Rome Rachael Rosales Lisa Rotenstein Alexis Roy Sarah Royston Hallie Rozansky Meghan Rudder Christine E Ryan Sanjay Salgado Pablo Sanchez Jennifer Schulte Aswin Sekar Nicholas Semenkovich Evan Shannon Neil Shaw Andrew Ben Shorten William Shrauner Lauren Sinnenberg James W Smithy Gregory Snyder Anirudh Sreekrishnan Hans Stabenau Eleni Stavrou Andrew Stergachis Robert Stern Alexander Stone Shervin Tabrizi Sam Tanyos Cristina Thomas Haley Thun Kristine Torres-Lockhart An Tran Carolyn Treasure Frederick D Tsai Stephen Tsaur Evan Tschirhart Justin Tuwatananurak Ramkumar V Venkateswaran Anastasia Vishnevetsky Lindsay Wahl April Wall Frances Wallace Elisa Walsh Priscilla Wang Heather B Ward Lindsay N Warner Lachelle D Weeks Kipp Weiskopf Jordan Wengrod Jessica N Williams Marisa Winkler Jeffrey L Wong Devin Worster Aileen Wright Caroline Wunsch Jamila S Wynter Chase Yarbrough Wai-Ying Yau Daniel Yazdi Jennifer Yeh Maria A Yialamas Nicholas Yozamp Marina Zambrotta Rebecca Zon

Circ Heart Fail 2019 Nov 29;12(11):e006214. Epub 2019 Oct 29.

Division of Cardiovascular Medicine, and Department of Medicine (E.F..L.), Brigham and Women's Hospital, Boston, MA.

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.

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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.119.006214DOI Listing
November 2019
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