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Observational Study
. 2018 May;6(5):413-420.
doi: 10.1016/j.jchf.2018.02.015.

African Americans Are Less Likely to Receive Care by a Cardiologist During an Intensive Care Unit Admission for Heart Failure

Khadijah Breathett  1 , Wenhui G Liu  2 , Larry A Allen  3 , Stacie L Daugherty  3 , Irene V Blair  4 , Jacqueline Jones  5 , Gary K Grunwald  6 , Marc Moss  7 , Tyree H Kiser  8 , Ellen Burnham  7 , R William Vandivier  7 , Brendan J Clark  7 , Eldrin F Lewis  9 , Sula Mazimba  10 , Catherine Battaglia  11 , P Michael Ho  12 , Pamela N Peterson  13
Affiliations
Observational Study

African Americans Are Less Likely to Receive Care by a Cardiologist During an Intensive Care Unit Admission for Heart Failure

Khadijah Breathett et al. JACC Heart Fail. 2018 May.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] JACC Heart Fail. 2018 Jul;6(7):617. doi: 10.1016/j.jchf.2018.05.010. JACC Heart Fail. 2018. PMID: 29957198 No abstract available.

Abstract

Objectives: This study sought to determine whether the likelihood of receiving primary intensive care unit (ICU) care by a cardiologist versus a noncardiologist was greater for Caucasians than for African Americans admitted to an ICU for heart failure (HF). The authors further evaluated whether primary ICU care by a cardiologist is associated with higher in-hospital survival, irrespective of race.

Background: Increasing data demonstrate an association between better HF outcomes and care by a cardiologist. It is unclear if previously noted racial differences in cardiology care persist in an ICU setting.

Methods: Using the Premier database, adult patients admitted to an ICU with a primary discharge diagnosis of HF from 2010 to 2014 were included. Hierarchical logistic regression models were used to determine the association between race and primary ICU care by a cardiologist, adjusting for patient and hospital variables. Cox regression with inverse probability weighting was used to assess the association between cardiology care and in-hospital mortality.

Results: Among 104,835 patients (80.3% Caucasians, 19.7% African Americans), Caucasians had higher odds of care by a cardiologist than African Americans (adjusted odds ratio: 1.42; 95% confidence interval: 1.34 to 1.51). Compared with a noncardiologist, primary ICU care by a cardiologist was associated with higher in-hospital survival (adjusted hazard ratio: 1.20, 95% confidence interval: 1.11 to 1.28). The higher likelihood of survival did not differ by patient race (interaction p = 0.32).

Conclusions: Among patients admitted to an ICU for HF, African Americans were less likely than Caucasians to receive primary care by a cardiologist. Primary care by a cardiologist was associated with higher survival for both Caucasians and African Americans.

Keywords: critical care; disparities; hospitals; race.

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Figures

Figure 1
Figure 1. Primary ICU Care by a Cardiologist for Caucasians Compared to African-Americans
Hospitals race indicates hospitals with both African-American and Caucasian patients. P-values are presented for groups and for the interaction of race with each subgroup.
Figure 2
Figure 2. Primary ICU Care by a Cardiologist for Caucasians Compared to African-Americans Among Specific Groups
* Any cardiology care includes both primary and non-primary ICU care by a cardiologist.
Figure 3
Figure 3. Primary ICU Care by a Cardiologist for Caucasians Compared to African-Americans By Time
Results before and after implementation of the Affordable Care Act Medicaid Expansion, January 2014, are demonstrated.
Figure 4
Figure 4. In-Hospital Survival With Admission by Cardiologist Compared to Non-Cardiologists in Caucasians and African-Americans
HR indicates hazard ratio. P-values are presented for groups and for the interaction of race with care of cardiologist versus non-cardiologist.
See this image and copyright information in PMC

Comment in

References

    1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation. 2017 CIR.0000000000000485. - PMC - PubMed
    1. Anonymous. [Accessed May 1, 2016];Products - Data Briefs - Number 231. 2015 Dec; Available at: http://www.cdc.gov/nchs/products/databriefs/db231.htm.
    1. Farmer SA, Kirkpatrick JN, Heidenreich PA, Curtis JP, Wang Y, Groeneveld PW. Ethnic and racial disparities in cardiac resynchronization therapy. Heart Rhythm Off J Heart Rhythm Soc. 2009;6:325–331. - PubMed
    1. Breathett K, Allen LA, Helmkamp L, et al. The Affordable Care Act Medicaid Expansion Correlated With Increased Heart Transplant Listings in African-Americans But Not Hispanics or Caucasians. JACC Heart Fail. 2017;5:136–147. - PMC - PubMed
    1. Phillips RS, Hamel MB, Teno JM, et al. Race, resource use, and survival in seriously ill hospitalized adults. The SUPPORT Investigators. J Gen Intern Med. 1996;11:387–396. - PubMed

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