Disparity of Care in the Acute Care of Patients With Heart Failure

Authors

  • Deborah B. Diercks MD, MSc,

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • Sean P. Collins MD, MSc,

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • Brian Hiestand MD, MPH,

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • J. Douglas Kirk MD,

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • Michael C. Kontos MD,

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • Christian Mueller MD,

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • Richard Nowak MD,

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • Alan Maisel MD,

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • W. Frank Peacock MD

    1. From the Department of Emergency Medicine, University of California at Davis (DBD, JDK), Davis, CA; the Department of Emergency Medicine, University of Cincinnati (SPC), Cincinnati, OH; the Department of Emergency Medicine, Ohio State University (BH), Columbus, OH; the Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University (MCK), Richmond, VA; the Department of Internal Medicine, University of Basel (CM), Basel, Switzerland; the Department of Emergency Medicine, Henry Ford Health System (RN), Detroit, MI; the Division of Cardiology, San Diego VA Medical Center (EM), San Diego, CA; and the Department of Emergency Medicine, Cleveland Clinic (WFP), Cleveland, OH.
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  • Research funding for the HEARD-IT study was provided by Inovise Medical Inc. The authors had full access to raw data.

  • Supervising Editor: Alan Jones, MD.

Address for correspondence and reprints: Deborah B. Diercks, MD, MSC; e-mail: dbdiercks@ucdavis.edu.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:15–21 © 2011 by the Society for Academic Emergency Medicine

Abstract

Objectives:  It has been well documented that screening, prevention, and treatment disparities in cardiovascular care exist. Most studies have focused on the outpatient setting. The purpose of the present analysis was to assess if a disparity of care exists in the care of emergency department (ED) patients with acute heart failure in a secondary analysis of the Heart Failure and Audicor Technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) multinational study.

Methods:  Only patients with an adjudicated diagnosis of acute heart failure were included in this analysis. Racial groups included in this analysis were limited to white and African American or black patients, due to their predominance in the cohort. Logistic regression including clinically relevant demographics, past medical history, exam, diagnostic tests, and adjudicated diagnosis of acute heart failure as covariates was performed to assess the association of race with treatment with a diuretic or nitroglycerin and 30-day death or readmission.

Results:  Of the cohort, 418 of 1,076 (38.8%) were included in the analysis. Median age was 69 years (interquartile range [IQR] = 55–79 years), 49% were white, and 51% were African American or black. There was no difference in the correct admitting diagnosis in the two groups (p = 0.83). Multivariate adjustment revealed that African American or black race was not associated with treatment with diuretics (adjusted odds ratio [OR] = 1.00, 95% confidence interval [CI] = 0.55 to 1.82) or nitrates (adjusted OR = 1.27, 95% CI = 0.76 to 2.13) in the ED. In a separate regression analysis there was no association with African American or black race with 30-day adverse events (adjusted OR = 1.22, 95% CI = 0.68 to 2.16).

Conclusions:  This secondary analysis of HEARD-IT data did not identify racial disparities in the treatment of adults with acute heart failure in the ED.

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