Quality of care of and outcomes for African Americans hospitalized with heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry.
OBJECTIVE
We sought to examine the characteristics, quality of care, and clinical outcomes for a large cohort of African-American patients hospitalized with heart failure (HF) in centers participating in a quality improvement initiative.


BACKGROUND
Heart failure in African Americans is characterized by variations in natural history, lesser response to evidence-based therapies, and disparate health care. We hypothesized that a performance improvement program will achieve similar adherence to quality measures in African Americans admitted with HF compared with non-African Americans.


METHODS
The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry-based performance-improvement program includes a pre-specified 10% subgroup with 60- to 90-day follow-up. Data on quality of care measures and outcomes were analyzed for 8,608 African-American patients compared with 38,501 non-African-American patients.


RESULTS
African Americans were significantly younger and more likely to receive evidence-based medications but less likely to receive discharge instructions and smoking cessation counseling. In multivariable analyses, African-American race was an independent predictor of lower in-hospital mortality (odds ratio 0.71; 95% confidence interval 0.57 to 0.87; p < 0.001) but similar hospital length of stay. After multivariable adjustment, post-discharge outcomes were similar for American-American and non-African-American patients, but African-American race was associated with higher angiotensin-converting enzyme inhibitor prescription and left ventricular function assessment; no other HF quality indicators were influenced by race.


CONCLUSIONS
In the context of a performance-improvement program, African Americans with HF received similar or better treatment with evidence-based medications, less discharge counseling, had better in-hospital survival, and similar adjusted risk of follow-up death/repeat hospital stay.
Yancy
Clyde W
CW
Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas 75246, USA. clydey@baylorhealth.edu
Abraham
William T
WT
Albert
Nancy M
NM
Clare
Robert
R
Stough
Wendy Gattis
WG
Gheorghiade
Mihai
M
Greenberg
Barry H
BH
O'Connor
Christopher M
CM
She
Lilin
L
Sun
Jie Lena
JL
Young
James B
JB
Fonarow
Gregg C
GC
D001741:Black or African American; D000368:Aged; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality / Q000208:ethnology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D010353:Patient Education as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D011787:Quality of Health Care; D012042:Registries; D012307:Risk Factors; D016540:Smoking Cessation; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology