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

Circ Heart Fail. 2019 Nov;12(11):e006214. doi: 10.1161/CIRCHEARTFAILURE.119.006214. Epub 2019 Oct 29.

Abstract

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.

Keywords: cardiologist; health equity; heart failure; hospitalization; racism.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Academic Medical Centers*
  • Aged
  • Aged, 80 and over
  • Black or African American*
  • Boston / epidemiology
  • Cardiology Service, Hospital*
  • Female
  • Health Services Accessibility*
  • Health Status Disparities
  • Healthcare Disparities / ethnology*
  • Heart Failure / diagnosis
  • Heart Failure / ethnology
  • Heart Failure / mortality
  • Heart Failure / therapy*
  • Hispanic or Latino*
  • Humans
  • Inpatients
  • Male
  • Middle Aged
  • Patient Admission*
  • Patient Readmission
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • White People*