title: Race and improvements in the use of guideline-recommended therapies for patients with heart failure: findings from IMPROVE HF.
abstract: BACKGROUND
  Race is associated with differences in use of guideline-recommended therapies for patients with heart failure (HF).
  
  
  OBJECTIVE
  To evaluate whether a practice-based performance improvement intervention is associated with similar improvements in evidence-based care for black, white, and race-undocumented patients.
  
  
  METHODS
  IMPROVE HF is a longitudinal evaluation of a performance improvement intervention on use of evidence-based therapies for outpatients with HF or prior myocardial infarction and left ventricular ejection fraction less than or equal to 35%. Data were available for 7605 patients. Changes in use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, aldosterone antagonist, cardiac resynchronization therapy, implantable cardioverter-defibrillator therapy, anticoagulant for atrial fibrillation, and HF education were analyzed by patient race (black, white, or undocumented/missing). Multivariate analyses identified variables independently associated with changes in each therapy.
  
  
  RESULTS
  There were 686 black patients (9.0%) and 3238 white patients (42.6%), and race was undocumented for 3537 (46.5%). Baseline use of B-blockers and aldosterone antagonists was significantly higher in black patients than in the other 2 groups, and use of aldosterone antagonists and HF education was higher among black patients at 24 months. Postintervention use of 4 of 7 therapies increased equitably for the 3 groups, and treatment rates were similar between black and white patients for 5 of 7 individual quality measures. Improvements in care were independent of race.
  
  
  CONCLUSIONS
  These findings offer some indication that race-based differences in delivery of evidence-based HF care may be decreasing in outpatient cardiology practices. Application of clinical decision support and performance feedback may facilitate equitable improvements in HF care in outpatient settings regardless of patient race.
  
  
  BACKGROUND
  NCT00303979, wwwv.clinicaltrials.gov.
authors.affiliation: University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma City, OK 73104, USA. dwight-reynolds@ouhsc.edu
authors.forename: Dwight
authors.initials: D
authors.lastname: Reynolds
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Anne B
authors.initials: AB
authors.lastname: Curtis
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Heywood
authors.forename: Mark L
authors.initials: ML
authors.lastname: Mcbride
authors.forename: Patches Johnson
authors.initials: PJ
authors.lastname: Inge
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Mary Norine
authors.initials: MN
authors.lastname: Walsh
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002309:Cardiology / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000208:ethnology* / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D012042:Registries; D012044:Regression Analysis; D044465:White People / Q000706:statistics & numerical data