title: Disparity of care in the acute care of patients with heart failure.
abstract: OBJECTIVE
  It has been well documented that screening, prevention, and treatment disparities in cardiovascular care exist. Most studies have focused on the outpatient setting. The purpose of the present analysis was to assess if a disparity of care exists in the care of emergency department (ED) patients with acute heart failure in a secondary analysis of the Heart Failure and Audicor Technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) multinational study.
  
  
  METHODS
  Only patients with an adjudicated diagnosis of acute heart failure were included in this analysis. Racial groups included in this analysis were limited to white and African American or black patients, due to their predominance in the cohort. Logistic regression including clinically relevant demographics, past medical history, exam, diagnostic tests, and adjudicated diagnosis of acute heart failure as covariates was performed to assess the association of race with treatment with a diuretic or nitroglycerin and 30-day death or readmission.
  
  
  RESULTS
  Of the cohort, 418 of 1,076 (38.8%) were included in the analysis. Median age was 69 years (interquartile range [IQR]=55-79 years), 49% were white, and 51% were African American or black. There was no difference in the correct admitting diagnosis in the two groups (p=0.83). Multivariate adjustment revealed that African American or black race was not associated with treatment with diuretics (adjusted odds ratio [OR]=1.00, 95% confidence interval [CI]=0.55 to 1.82) or nitrates (adjusted OR=1.27, 95% CI=0.76 to 2.13) in the ED. In a separate regression analysis there was no association with African American or black race with 30-day adverse events (adjusted OR=1.22, 95% CI=0.68 to 2.16).
  
  
  CONCLUSIONS
  This secondary analysis of HEARD-IT data did not identify racial disparities in the treatment of adults with acute heart failure in the ED.
authors.affiliation: Department of Emergency Medicine, University of California at Davis, Davis, CA, USA. dbdiercks@ucdavis.edu
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.forename: Brian
authors.initials: B
authors.lastname: Hiestand
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Kirk
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kontos
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
mesh_terms: D000208:Acute Disease; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006333:Heart Failure / Q000208:ethnology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American