Racial variations in quality of care and outcomes in an ambulatory heart failure cohort.
BACKGROUND
Few recent studies have demonstrated similar quality of care for hospitalized black and white patients with heart failure (HF). However, systematic evaluation of racial differences in both the quality of care and outcomes is needed in the outpatient setting, where most patients with HF are treated and where care may be more fragmented.


METHODS
We examined racial differences in quality-of-care measures and outcomes of 1-year mortality and hospitalization in a national cohort of 18,611 ambulatory patients with HF treated at Veterans Affairs medical centers between October 2000 and September 2002.


RESULTS
Black patients were more likely to have left ventricular ejection fraction assessment than whites (risk-adjusted OR 1.29, 95% CI 1.11-1.49). In patients with left ventricular ejection fraction <40%, blacks were as likely as whites to be on treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (risk-adjusted OR 1.06, 95% CI 0.85-1.33) and beta-blockers (risk-adjusted OR 0.92, 95% CI 0.79-1.07). However, black patients more frequently had uncontrolled hypertension and were more likely to be hospitalized for any cause (OR 1.20, 95% CI 1.08-1.33) or for HF (OR 1.43, 95% CI 1.23-1.66), although 1-year mortality did not differ by race (OR 1.03, 95% CI 0.89-1.20).


CONCLUSIONS
In a financially "equal access" health care system, the quality of outpatient HF care assessed by select quality measures and 1-year mortality was similar in black compared to white patients. However, blacks were more likely to be hospitalized, especially with HF. Identifying and targeting potentially modifiable factors such as uncontrolled hypertension in black patients may narrow the racial gap in hospitalizations.
Deswal
Anita
A
Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX 77030, USA adeswal@bcm.tmc.edu
Petersen
Nancy J
NJ
Urbauer
Diana L
DL
Wright
Steven M
SM
Beyth
Rebecca
R
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality; D006760:Hospitalization; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D051437:Renal Insufficiency / Q000208:ethnology; D012189:Retrospective Studies; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology; D014728:Veterans; D044465:White People / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors