Does racial bias exist in the medical management of heart failure?
BACKGROUND
It is suspected that effective therapies are often underutilized in black compared with white patients with coronary artery disease (CAD).


OBJECTIVE
We hypothesized that an unfavorable bias may exist against black patients in the medical management of heart failure.


METHODS
In 566 consecutive adult subjects who were discharged alive from the hospital with a principal discharge diagnosis of heart failure, we assessed the effect of patient race on utilization of classes of medications (angiotensin-converting enzyme inhibitors [ACEI], digitalis, diuretic agents) and combinations of medications (effective vasodilators, i.e., ACEI or combined hydralazine and nitrate; effective combination therapy, i.e., effective vasodilator with digitalis and diuretic) known to be beneficial in symptomatic heart failure.


RESULTS
Compared with black patients (n = 182), white patients were older, had a higher incidence of coronary artery disease, lower incidence of hypertension, and lower serum creatinine and left ventricular end-diastolic diameter. In crude analyses, the utilization of all medications was similar between white and black patients. After adjustment for clinical differences, black patients were more likely to receive ACEI (adjusted odds ratio [OR] = 1.84; 95% confidence interval [CI] 1.13-3.01), effective vasodilators (OR = 1.97; CI 1.20-3.23), and effective combination therapy (OR = 1.66; CI 1.02-2.69) than white patients at the time of discharge from the hospital. No multivariate association was seen between patient race and use of digoxin or diuretics. In an analysis of subsets of patients with ejection fraction < 45% (n = 260), no association was seen between patient race and utilization of effective medical therapy.


CONCLUSIONS
Our results show no unfavorable bias against black patients with decompensated heart failure.
Harjai
Kishore J
KJ
Department of Cardiology, Ochsner Clinic, New Orleans, Louisiana, USA. kharjai@beaumont.edu
Nunez
Eduardo
E
Shah
Mehul
M
Newman
Jeff
J
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019468:Disease Management; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011287:Prejudice; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000523:psychology / Q000628:therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D014665:Vasodilator Agents