TY - JOUR
T1 - Racial variations in quality of care and outcomes in an ambulatory heart failure cohort
AU - Deswal, Anita
AU - Petersen, Nancy J.
AU - Urbauer, Diana L.
AU - Wright, Steven M.
AU - Beyth, Rebecca
N1 - Funding Information:
This study was supported in part by grants from the VA Health Services Research and Development Service (no. IIR 02-082-1) and the VA Clinical Science Research and Development Service. Dr Deswal is a recipient of a VA Advanced Clinical Research Career Development Award from the VA Cooperative Studies Program. Dr Beyth was a recipient of an Advanced Research Career Development Award from the VA Health Services Research and Development Service during this work. The views expressed in the article are those of the authors and do not necessarily represent those of the Department of Veterans Affairs.
PY - 2006/8
Y1 - 2006/8
N2 - Background: Few recent studies have demonstrated similar quality of care for hospitalized black and white patients with heart failure (HF). However, systematic evaluation of racial differences in both the quality of care and outcomes is needed in the outpatient setting, where most patients with HF are treated and where care may be more fragmented. Methods: We examined racial differences in quality-of-care measures and outcomes of 1-year mortality and hospitalization in a national cohort of 18 611 ambulatory patients with HF treated at Veterans Affairs medical centers between October 2000 and September 2002. Results: Black patients were more likely to have left ventricular ejection fraction assessment than whites (risk-adjusted OR 1.29, 95% CI 1.11-1.49). In patients with left ventricular ejection fraction <40%, blacks were as likely as whites to be on treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (risk-adjusted OR 1.06, 95% CI 0.85-1.33) and β-blockers (risk-adjusted OR 0.92, 95% CI 0.79-1.07). However, black patients more frequently had uncontrolled hypertension and were more likely to be hospitalized for any cause (OR 1.20, 95% CI 1.08-1.33) or for HF (OR 1.43, 95% CI 1.23-1.66), although 1-year mortality did not differ by race (OR 1.03, 95% CI 0.89-1.20). Conclusions: In a financially "equal access" health care system, the quality of outpatient HF care assessed by select quality measures and 1-year mortality was similar in black compared to white patients. However, blacks were more likely to be hospitalized, especially with HF. Identifying and targeting potentially modifiable factors such as uncontrolled hypertension in black patients may narrow the racial gap in hospitalizations.
AB - Background: Few recent studies have demonstrated similar quality of care for hospitalized black and white patients with heart failure (HF). However, systematic evaluation of racial differences in both the quality of care and outcomes is needed in the outpatient setting, where most patients with HF are treated and where care may be more fragmented. Methods: We examined racial differences in quality-of-care measures and outcomes of 1-year mortality and hospitalization in a national cohort of 18 611 ambulatory patients with HF treated at Veterans Affairs medical centers between October 2000 and September 2002. Results: Black patients were more likely to have left ventricular ejection fraction assessment than whites (risk-adjusted OR 1.29, 95% CI 1.11-1.49). In patients with left ventricular ejection fraction <40%, blacks were as likely as whites to be on treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (risk-adjusted OR 1.06, 95% CI 0.85-1.33) and β-blockers (risk-adjusted OR 0.92, 95% CI 0.79-1.07). However, black patients more frequently had uncontrolled hypertension and were more likely to be hospitalized for any cause (OR 1.20, 95% CI 1.08-1.33) or for HF (OR 1.43, 95% CI 1.23-1.66), although 1-year mortality did not differ by race (OR 1.03, 95% CI 0.89-1.20). Conclusions: In a financially "equal access" health care system, the quality of outpatient HF care assessed by select quality measures and 1-year mortality was similar in black compared to white patients. However, blacks were more likely to be hospitalized, especially with HF. Identifying and targeting potentially modifiable factors such as uncontrolled hypertension in black patients may narrow the racial gap in hospitalizations.
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U2 - 10.1016/j.ahj.2005.12.004
DO - 10.1016/j.ahj.2005.12.004
M3 - Article
C2 - 16875921
AN - SCOPUS:33746373114
SN - 0002-8703
VL - 152
SP - 348
EP - 354
JO - American Heart Journal
JF - American Heart Journal
IS - 2
ER -