Black heart failure patients 42% less likely to receive ICU care from cardiologists

Black Americans admitted to intensive care units (ICUs) with heart failure are 42 percent less likely to receive primary care from a cardiologist, which is associated with better survival odds for all patients.

Lead researcher Khadijah Breathett, MD, MS, and colleagues arrived at these findings by studying 104,835 ICU admissions from the Premier Healthcare Database from 2010 to 2014. Eighty percent of the patients were white and 20 percent were black.

Regardless of race, primary ICU care by cardiologists was associated with 20 percent lower odds of in-hospital mortality. But black patients remained significantly less likely to receive this specialty care than whites, the researchers reported in JACC: Heart Failure, despite black Americans having the highest risk of heart failure and heart failure-related mortality of any racial group in the United States.

“Given a significant percentage of (black) patients either with private insurance or Medicare, can we continue to blame the disparity in care to lack of access or insurability?” Ileana L. Pina, MD, MPH, professor of epidemiology and public health at Albert Einstein College of Medicine, wrote in an accompanying editorial. “Is it not time to consider preconceived notions of access and inherent, although unrecognized, racial bias and stereotyping that lead to racial health disparities?”

Breathett and coauthors found differences in treatment by gender as well. White women were 30 percent more likely to receive care from a cardiologist than black women, while white men were 50 percent more likely than black men to receive ICU care from a cardiologist.

White patients were 11 years older on average and more likely to have atrial arrhythmias, chronic obstructive pulmonary disease and depression. Black patients, on the other hand, were more likely to have diabetes, chronic kidney disease and obesity, but the researchers attempted to adjust for all of these variables in their calculations.

“Both patients and physicians should know that racial disparities exist in healthcare,” Breathett said in a press release. “Patients must be their own advocates and not fear getting a second opinion, especially when they believe they are not being heard. Physicians should adhere to guideline recommendations, advocate for underserved populations and be aware of implicit biases that may adversely affect clinical management.”

Breathett said reward programs could incentivize hospitals to reduce disparities in care while also penalizing centers that provide poor care.

“It is time to change the operations of the U.S. healthcare system,” she said.