Abstract 1552: African Americans With Heart Failure Are More Likely to Receive Evidence Based Medications and Have Lower Risk of Mortality in the Mid-michigan Guidelines Applied in Practice for Heart Failure Study
BACKGROUND: Studies have demonstrated racial disparity in the treatment and outcomes for patients with cardiovascular disease. However, systematic evaluation of racial differences in both the quality of care and outcomes for patients with heart failure (HF) is still lacking.
OBJECTIVE: To determine the differences in quality of care and patient outcomes between black and white patients in the ACC Mid-Michigan GAP-HF (Guidelines Applied in Practice for Heart Failure) initiative.
METHODS: We prospectively analyzed 2825 whites and 653 black patients from the 2003–2004 GAP-HF quality improvement program. To investigate the relationship between race and mortality, multivariable logistic regression models were created for outcomes of 30-day, 60-day, 90-day, and 180-day death, adjusting for characteristics that differed between blacks and whites as well as variables known to be associated with mortality.
RESULTS: Blacks were more hypertensive (87.7% vs. 79.2%; p<0.001). Black patients had higher rates of beta-blocker use than whites (75.2% vs. 66.5%; p <0.005), and demonstrated trends toward more frequent treatment with ACEI/ARB (80.2% vs 77.8% p=0.211) and Aldosterone inhibitors (55.6% vs. 47.6% p=0.090). White patients had higher rates of pneumococcal vaccination documentation (53.4% vs. 48.2% p=0.017). Other performance measures (Warfarin for atrial fibrillation, discharge instructions, and smoking cessation advice) did not differ between blacks and whites. Blacks had lower adjusted mortality rates at 30days (OR 0.48, 95% CI 0.25– 0.92), 60days (0.40, 0.24 – 0.69), 90days (0.36, 0.22– 0.60) and 180days (0.45, 0.31– 0.67) after hospitalization compared to whites. There were no significant differences in readmission rates for black and white patients.
CONCLUSION: These data demonstrate that blacks treated for HF in these Mid-Michigan GAP hospitals are more likely to receive evidence based medications and have lower mortality rates up to 180 days after hospitalization compared to their white counterparts. Further study is needed to understand these racial differences in HF outcomes.