title: Association of race/ethnicity with clinical risk factors, quality of care, and acute outcomes in patients hospitalized with heart failure.
abstract: BACKGROUND
  Black and Hispanic populations are at increased risk for developing heart failure (HF) at a younger age and experience differential morbidity and possibly differential mortality compared with whites. Yet, there have been insufficient data characterizing the clinical presentation, quality of care, and outcomes of patients hospitalized with HF as a function of race/ethnicity.
  
  
  METHODS
  We analyzed 78,801 patients from 257 hospitals voluntarily participating in the American Heart Association's Get With The Guidelines-HF Program from January 2005 thru December 2008. There were 56,266 (71.4%) white, 17,775 (22.6%) black, and 4,760 (6.0%) Hispanic patients. In patients hospitalized with HF, we sought to assess clinical characteristics, adherence to core and other guideline-based HF care measures, and in-hospital mortality as a function of race and ethnicity.
  
  
  RESULTS
  Relative to white patients, Hispanic and black patients were significantly younger (median age 78.0, 63.0, 64.0 years, respectively), had lower left ventricular ejection fractions, and had more diabetes mellitus and hypertension. With few exceptions, the provision of guideline-based care was comparable for black, Hispanic, and white patients. Black and Hispanic patients had lower in-hospital mortality than white patients: black/white odds ratio 0.69, 95% CI 0.62-0.78, P < .001 and Hispanic/white odds ratio 0.81, 95% CI 0.67-0.98, P = .03.
  
  
  CONCLUSIONS
  Hispanic and black patients hospitalized with HF have more cardiovascular risk factors than white patients; however; they have similar or better in-hospital mortality rates. Within the context of a national HF quality improvement program, HF care was equitable and improved in all racial/ethnic groups over time.
authors.affiliation: Duke Clinical Research, Durham, NC, USA. kevin.thomas@duke.edu
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Thomas
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Paul
authors.initials: P
authors.lastname: Heidenreich
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
mesh_terms: D001741:Black or African American; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality*; D006630:Hispanic or Latino; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors