Minority patients face deep-rooted inequities in heart failure care

Research out of Brigham and Women’s Hospital in Boston found heart failure patients who self-identify as black, Latinx or female are less likely to be admitted to the hospital’s cardiology department, suggesting admission bias might be a partial contributor to known racial disparities in HF outcomes.

Co-senior author Eldrin Lewis, MD, MPH, and colleagues at the Brigham launched the study as part of the Department of Medicine’s Health Equity Committee, which formed in 2017. It was one of the committee’s first projects and focused on race, age and gender as a factor of heart failure care in the U.S.

The study included patients who presented to the Brigham’s emergency department between 2008 and 2017 with a principal diagnosis of heart failure, all of whom were admitted to either the hospital’s general medicine or cardiology service following the ED. Of 430 Latinx, 872 black and 1,921 white patients, 1,147 were admitted to general medicine and 2,117 were admitted to cardiology.

After adjusting for clinical and demographic variables, Lewis et al. found that black and Latinx HF patients were significantly more likely to be admitted to the general medicine service than white patients. Female sex and age over 75 years were also independently linked to lower rates of admission to the cardiology service.

The authors didn’t report any differences in 30-day readmission rates during the study period, but they said that finding should be interpreted with caution.

“This analysis reflects our institution’s strong tradition of self-reflection and transparency to make care better for all our patients,” Lewis, a CV medicine and heart transplantation specialist at Brigham and Women’s, said in a statement. “We hope other institutions and clinicians will be equally committed to addressing inequities in their own contexts, systems and care settings. Ongoing institutional insistence on self-critique and the recognition of the pervasiveness of structural racism and bias will increase the likelihood of success in achieving health equity at all U.S. institutions.”

Another project of the Brigham’s Health Equity Committee involves surveying physicians involved in the admissions process, as well as admitted patients, to better understand the mechanisms behind such decision-making. The committee is also reportedly working to improve care for patients with HF who are admitted to the general medicine service and might have trouble seeing a cardiologist.

“At a macro level, recognizing that inequities like those we identified are pervasive, we believe that collaboration across services and provider roles, shared definitions and analysis of structural drivers of inequity, and a collective commitment to improvement are essential to minimizing these gaps,” Lewis said.