Race, Quality of Care, and Outcomes of Elderly Patients Hospitalized with Heart Failure

Abstract

Context: Black patients hospitalized with heart failure reportedly receive poorer quality of care and have worse outcomes than white patients. Because previous studies have been based on selected patient populations treated more than a decade ago, it is unclear if racial differences in quality of care and outcomes currently exist in the United States. Objective: To evaluate differences in quality of care and patient outcomes between black and white Medicare beneficiaries hospitalized with heart failure. Design: Retrospective analysis of medical record data systematically collected for the National Heart Failure Project. Setting and Patients: Nationwide US sample of 29732 fee-for-service Medicare beneficiaries hospitalized with heart failure in 1998 and 1999. Main Outcome Measures: Prescription of angiotensin-converting enzyme (ACE) inhibitors, measurement of left ventricular ejection fraction (LVEF), readmission within 1 year of discharge, and mortality within 30 days and 1 year of admission. Results: Black patients and white patients had similar crude rates of LVEF assessment (67.8% black vs 66.6% white; P=.29). Among patients classified as ideal for ACE inhibitor use, black patients had higher crude rates of ACE inhibitor use than white patients (81.0% vs 73.8% white; P < .001) and 1-year (31.5% vs 40.1%;