U.S. hospitals participating in the American Heart Association's Get With The Guidelines®-Heart Failure quality improvement program provided equitable care for blacks, Hispanics and whites, according to a new study.
In the study, published in the April 2011 issue of American Heart Journal, care for heart failure patients of all racial/ethnic groups also improved over time in participating hospitals.
Studies have shown that blacks and Hispanics are at increased risk for developing heart failure at younger ages compared to whites. Blacks and Hispanics also have higher long-term death and complication rates from heart failure than whites.
"Yet, there have been insufficient data characterizing the clinical presentation, quality of care, and outcomes of patients hospitalized with heart failure as a function of race and ethnicity," said Kevin L. Thomas, M.D., the study's lead author and assistant professor of medicine, department of medicine/division of cardiology at Duke University Medical Center in Durham, N.C. "That's why we did this study."
Thomas and colleagues analyzed 78,801 patients from 257 hospitals voluntarily participating in Get With The Guidelines-Heart Failure from January 2005 through December 2008. They looked at patients' clinical characteristics (or risk factors for heart failure); hospitals' adherence to recommended quality of care guidelines for heart failure patients; and in-hospital death rates, as a function of race and ethnicity.
They found:
- With few exceptions, the hospitals studied provided equitable guidelines-based care for black, Hispanic and white heart failure patients, and the consistent use of the quality care guidelines for all patients improved over time.
- Hispanic heart failure patients were an average of 63 years old, black patients were an average of 64 and whites were an average of 78 years old.
- Hispanic and black patients were more likely than white patients to present with heart disease risk factors, such as a decreased ejection fraction or pumping function of the heart, diabetes mellitus and high blood pressure.
- Black patients had a 31 percent lower in-hospital death rate than whites and Hispanics had a 19 percent lower death rate than whites.
"The age issue is an important one," Thomas said. "We traditionally think of heart failure as a disease of the elderly. But we identified a subgroup of hospitalized heart failure patients between ages 40 and 50, of which blacks and Hispanics made up a larger percentage. That tells us that any initiative to prevent heart failure and educate people about it should start at earlier ages - perhaps in the 20s or 30s."
White hospitalized heart failure patients may be dying more often than minorities because white patients are more likely to have heart failure as a result of having had heart attacks, Thomas said. Blacks and Hispanics often suffer from heart failure because of other reasons, such as high blood pressure or diabetes.
"Why this difference exists requires further study," Thomas said.
The study is among the few in which researchers focused on heart failure characteristics of Hispanics, the most rapidly growing group in the United States.
"Those of us who do research on healthcare disparities know there are a lot of things that lead to those disparities," Thomas said. "This and other studies show that Get With The Guidelines quality improvement initiatives are successful available strategies to provide quality treatment for all individuals, independent of race, age or gender."
Co-authors are Adrian F. Hernandez, M.D., M.H.S.; David Dai, M.S.; Paul Heidenreich, M.D.; Gregg C. Fonarow, M.D.; Eric D. Peterson, M.D., M.P.H.; and Clyde W. Yancy, M.D. Author disclosures are on the manuscript.
The Get With The Guidelines®-Heart Failure program, provided by the American Heart Association, is currently supported by an unrestricted educational grant from Medtronic, Inc., and has been funded in the past through support from GlaxoSmithKline, Ortho-McNeil and the American Heart Association Pharmaceutical Roundtable.
Source:
American Heart Association