Access to cardiac units may explain racial gap for heart failure patients

Black or Latino patients with heart failure are less likely to be admitted to specialized cardiology units, say researchers who suggest that disparity – and not biology – may help explain racial gaps in how patients recover.

The findings come from a review of 10 years of records from nearly 2,000 patients treated for heart failure at Brigham and Women's Hospital in Boston. Results were published Tuesday in the American Heart Association's journal Circulation: Heart Failure.

Patients in the study received either specialized cardiac care or general care. Those who were admitted to a heart unit had a 16% lower rate of hospital readmission within 30 days. Readmission within a month of discharge may signal poorly managed disease and can foreshadow a worse overall prognosis, the researchers said. 

Patients who self-identified as black were 9% less likely to be admitted to specialized units. Patients who self-identified as Latinx, a gender-neutral term describing a person of Latin American origin or descent, were 17% less likely to be admitted to specialized units. 

Female heart failure patients, and those older than 75, were also more likely to be treated on a general medicine floor.

"These outcomes are both unjust and avoidable, and in no way unique to a single institution," said co-lead study author Dr. Lauren Eberly. She was a resident physician at Brigham and Women's Hospital when the study was conducted and is now a cardiovascular medicine fellow at the University of Pennsylvania.

Racial inequities and higher readmission rates among minority populations have been documented in previous studies. This study is one of the first to suggest that admission practices might partially explain the disparities in outcomes for heart failure, a chronic, progressive condition in which the heart muscle is unable to pump enough blood.

The researchers emphasized that the apparent disparities in outcomes probably stem from differences in care rather than biological differences for people of different ancestries.

Black and Latinx patients were less likely to be under the care of a cardiologist as an outpatient at the time of hospitalization — the strongest predictor of admission to a cardiology unit, according to the study. The authors also suggested patients' mistrust of the health care system may make some less likely to advocate for specialized care. The authors also suggested implicit bias in the system probably contributes as well.

"Future research on health inequities should seriously consider looking beyond biological differences between races to critical issues of inequities in access to care as key drivers of racial disparities," said Dr. Michelle Morse, a senior author on the study. She is a hospitalist at Brigham and Women's Hospital and assistant professor of medicine at Harvard Medical School.

The researchers suggested guidelines for admissions staff and racial equity training for doctors could help close the gap. Increased staff education also could help to standardize heart failure care between cardiology and general medicine units. Additional tools also might ensure all patients are followed by a cardiologist after leaving the hospital, the researchers said.

"We hope that our findings will encourage other institutions to investigate how racial bias influences care decisions at their center as Brigham and Women's Hospital supported our inquiry," Eberly said. "We recommend that care delivery be designed to prioritize the care of our most marginalized patients. Only then can we start to eliminate inequity."

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