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Black patients with heart failure have similar quality of care, but better survival than white patients

Yale University : 20 May, 2003  (New Product)
In the most recent large national study of heart failure care, Yale School of Medicine researchers found that elderly black patients hospitalized for heart failure received similar quality of care as white patients and had higher survival rates than whites up to one year afterwards.
'Our findings demonstrate that there are no racial differences in the quality of health care provided to Medicare beneficiaries hospitalized for heart failure,' said Harlan Krumholz, M.D., professor of medicine at Yale School of Medicine, director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, and the senior author on the study.

Published in the May 21 issue of the Journal of the American Medical Association, the study showed that elderly black heart failure patients had statistically similar rates of left ventricular ejection fraction (a measure of how well the heart is pumping) assessment as white patients (67.8% versus 66.6%).

Using data from the National Heart Care/National Heart Failure Project, a Centers for Medicare & Medicaid Services initiative to improve the care of Medicare patients hospitalized for heart failure in 1998 and 1999, the team evaluated 29,732 patients to assess if there were differences in quality of care and outcomes between black patients and white patients hospitalized for heart failure.

The researchers said they were surprised to find that more black patients were prescribed angiotensin-converting enzyme inhibitors, drugs used to treat patients with heart failure, than white patients (81.0% versus 73.8%). However, this difference was attenuated after accounting for other dissimilarities between blacks and whites.

The researchers found that black patients had a lower mortality rate than white patients 30 days (6.3% versus 10.7%) and one year after admission (31.5% versus 40.1%). Black patients were more likely to be re-hospitalized than white patients (68.2% versus 63.0%), although it is unclear if this difference was due to post-discharge care or other factors.

The issue of disparities in health care and outcomes has received significant attention. However, Krumholz noted that most investigators have focused on documenting differences in treatment use by race. This study extends previous work by determining whether differences in treatment reflect poorer quality care.

'Contrary to previous reports, black patients in fact have a better prognosis than white patients,' said the study's first author Saif Rathore, lecturer in the Department of Internal Medicine at Yale. 'It is unclear what factors may account for this lower mortality, although black heart failure patients who survive to old age may represent a healthier population than their white counterparts.'

The researchers' findings also have relevance to the larger body of research assessing racial differences in health care use. 'We believe the lack of a racial difference in quality of care in our study indicates that racial disparities in health care may not exist for all clinical conditions or populations,' noted Rathore. 'Rather than simply assuming disparities exist, our findings underscore the need to study patterns of care for individual clinical conditions in order to understand why there are disparities for some conditions and in some populations, but not others.'
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