AHJ: Getting with the guidelines can help provide equitable care

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Despite the fact that Hispanic and black heart failure (HF) patients usually fair worse than white patients in terms of cardiovascular risk factors, when hospitals participated in the American Heart Association’s Get with the Guidelines HF quality improvement programs, outcomes were similar across all racial and ethnic groups, according to the results of a study published in the April issue of the American Heart Journal.

Kevin L. Thomas, MD, of the Duke University School of Medicine in Durham, N.C., and colleagues analyzed 78,801 patients from 257 hospitals who participated in the AHA’s Get with the Guidelines HF program between January 2005 and December 2008.

Of the 78,801 patients identified, 71.4 percent were white, 22.6 percent were black and 6 percent were Hispanic. Thomas et al sought to assess the patients’ clinical characteristics, adherence to core and guideline-based HF measures and in-hospital mortality.

Hispanic and black patients were younger than whites who had a median age of 78, 63 and 64 years, respectively. These patients also had lower left ventricular ejection fractions (LVEF) but more incidences of diabetes and hypertension.

"The age issue is an important one," Thomas said. "We traditionally think of heart failure as a disease of the elderly. But we identified a subgroup of hospitalized heart failure patients between ages 40 and 50, of which blacks and Hispanics made up a larger percentage. That tells us that any initiative to prevent heart failure and educate people about it should start at earlier ages — perhaps in the 20s or 30s."

And while black and Hispanic patients had lower in-hospital mortality than compared with white patients, overall the researchers reported that guideline-based HF care was comparable for black, Hispanic and white patients.

Additionally, black patients had a 31 percent lower in-hospital death rate compared with whites and Hispanics had a 19 percent lower death rate compared with whites.

"This and other studies show that Get with the Guidelines quality improvement initiatives are successful available strategies to provide quality treatment for all individuals, independent of race, age or gender,” Thomas offered.

Utilizing initiatives such as Get with the Guidelines, among others, can help close the gap within care, particularly across all racial and ethnic groups.