Black and Latinx patients are less likely to receive specialty cardiology services during admission for heart failure (HF) compared with white patients, a study in Circulation: Heart Failure suggests.
The study was a retrospective analysis of patients self-referred to the emergency department of an urban tertiary academic hospital with large general medicine and specialty cardiology services. A total of 1967 patients with principle HF diagnoses were admitted to either general medicine or cardiology services between September 2008 and November 2017. Researchers conducting the retrospective cohort study identified the self-reported racial identity of patients from their electronic medical records. Patients who were black (23.6%), white (66.7%), and Latinx (ie, persons of Latin American origin or descent [9.7%]) were included.
Researchers assessed the association between race and admission to a specialty cardiology service within the institution. The study also examined the relationships between race, admission service, and 30-day readmission and mortality.
Whites had significantly higher rates of admission to the specialty cardiology service compared with black patients (adjusted rate ratio [ARR], 0.91; 95% CI, 0.84-0.98; P =.019) and Latinx patients (ARR, 0.83; 95% CI, 0.72-0.97; P =.017). Independent predictors of lower admission rates to the cardiology service included female sex, age >75 years (ARR, 0.85; 95% CI, 0.77-0.95; P =.003), chronic pulmonary disease (ARR, 0.85; 95% CI, 0.80-0.91; P <.001), end-stage renal disease (ARR, 0.47; 95% CI, 0.36-0.61; P <.001), and having been seen by a primary care physician at the institution within the past year (ARR, 0.88; 95% CI, 0.82-0.93; P <.0001). Conversely, independent predictors of admission to the cardiology service included cardiac valvular disease (ARR, 1.11; 95% CI, 1.05-1.18; P =.0002), arrhythmia (ARR, 1.14; 95% CI, 1.03-1.27; P =.014), and being seen in a cardiology clinic at the institution within the past year (ARR, 1.31; 95% CI, 1.23-1.39; P <.001).
In the adjusted analysis, black race was independently associated with a reduced mortality risk within 30 days (hazard ratio [HR], 0.52; 95% CI, 0.30-0.91; P =.02). No difference was observed between Latinx patients and white patients with regard to 30-day mortality (HR, 0.89; 95% CI, 0.46-1.73; P =.73). Additionally, there was no association between admission to the cardiology service and mortality within 30 days (HR, 0.83; 95% CI, 0.55-1.24; P =.36). There was also no association between race and readmission to the cardiology service within 30 days (black vs white: HR, 1.09; 95% CI, 0.92-1.29; P =.31; Latinx vs white: HR, 1.14; 95% CI, 0.91-1.42; P =.27). Initial admission to the cardiology service, however, was associated with 30-day readmission (HR, 0.84; 95% CI, 0.72-0.97; P =.018).
Limitations of the study include the retrospective and observational nature of the study, and the lack of adjustment for HF severity and practice variability among clinicians.
The researchers concluded that “differential access to specialty care within institutions may be an important driver of health inequities” and should be further explored in future disparities research to identify causal factors.
Eberly LA, Richterman A, Beckett AG, et al. Identification of racial inequities in access to specialized inpatient heart failure care at an academic medical center. Circ Heart Fail. 2019;12(11):e006214.