Hospitals Serving High Proportions of Black Patients Deliver Equivalent HF Care

Care for heart failure (HF) was shown to be equivalent at hospitals that cared for a high proportion of Black patients compared with care delivered at hospitals that did not serve a similar population, according to study results published recently in JAMA Cardiology.

This investigation was a cross-sectional analysis of data from the Get With the Guidelines HF Registry, and their conclusion was reached after seeing similar performance outcomes on 11 of the 14 quality measures included in the registry. All of the patients (N = 422,483) included in this analysis experienced a hospitalization between January 1, 2016, and December 1, 2019, for a primary diagnosis of HF at a site that had incorporated the Get With the Guidelines program, and their data were analyzed between May and November 2022. Fifty-three percent were male patients, 67.4% were White, and the mean age was 73 years.

Twenty percent of the 480 hospitals that have incorporated the Get With the Guidelines registry program served high proportions of Black patients.

“Black adults with HF disproportionately experience higher population-level mortality than White adults with HF,” the study investigators wrote. “Understanding whether care quality differs between hospitals that care for a high proportion of Black adults compared with those that do not is critically important.”

The study investigators highlighted the following equivalent results that were seen when comparing outcomes between the hospitals that care for more Black patients vs those that did not, respectively:

• 92.7% vs 92.4%: use of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blocker (ARBs)/angiotensin receptor neprilysin inhibitors (ARNIs) for left ventricle systolic dysfunction (odds ratio [OR], 0.91; 95% CI, 0.65-1.27)
• 94.7% vs 93.7%: use of evidence-based β-blockers (OR, 1.02; 95% CI, 0.82-1.28)
• 14.3% vs 16.8%: ARNI at discharge (OR, 0.74; 95% CI, 0.54-1.02)
• 88.8% vs 87.5%: anticoagulation for atrial fibrillation/flutter (OR, 1.05; 95% CI, 0.76-1.45)
• 70.9% vs 71.0%: implantable cardioverter-defibrillator (ICD) counseling/placement/prescription at discharge (OR, 0.75; 95% CI, 0.50-1.13)

However, patients receiving care at hospitals that served high proportions of Black patients were also less likely to receive the following upon discharge:

• 70.4% vs 80.1%: follow-up visit within 7 days (OR, 0.68; 95% CI, 0.53-0.86)
• 50.6% vs 53.5%: cardiac resynchronization device placement/prescription (OR, 0.63; 95% CI, 0.42-0.95)
• 50.4% vs 53.5%: an aldosterone antagonist (OR, 0.69; 95% CI, 0.50-0.97)

In particular, mortality at 30 days was similar among patients with Medicare coverage aged 65 years and older (HR, 0.92; 95% CI, 0.84-1.02). However, hospitals caring for more Black patients had higher rates of 30-day readmission, which equated to a 14% greater risk of this outcome (HR, 1.14; 95% CI, 1.02-1.26).

Overall, the study investigators noted, “defect-free care was similar between both groups of hospitals, and there were no significant within-hospital differences in quality for Black patients vs White patients.”

The 14 measures contained in the Get With the Guidelines registry are ACE inhibitors/ARBs/ARNIs at discharge, evidence-based β-blocker use, smoking cessation counseling, aldosterone antagonist at discharge, ARNIs at discharge, anticoagulation for atrial fibrillation or atrial flutter, appropriate use of hydralazine/nitrates at discharge, venous thromboembolism prophylaxis in hospital, cardiac resynchronization-defibrillator therapy/pacing therapy placement or prescription at discharge, ICD counseling or placement at discharge, influenza vaccination during flu season, pneumococcal vaccination prior to discharge, postdischarge follow-up appointment, and follow-up appointment scheduled within 7 days after discharge.

Reference

Diamond J, Ayodele I, Fonarow GC, et al. Quality of care and clinical outcomes for patients with heart failure at hospitals caring for a high proportion of Black adults: Get With The Guidelines–Heart Failure Registry. JAMA Cardiol. Published online April 19, 2023. doi:10.1001/jamacardio.2023.0695