Racial and Ethnic Disparities in the Outcomes and Treatment of Patients Admitted with Heart Failure: A Nationwide Analysis.

Background/

Objectives

Heart failure is the leading cause of hospital admission and mortality. Racial disparities have been demonstrated in various cardiovascular disorders; however, the data for in-hospital outcomes, complications, and procedural rates are limited.

Methods

Utilizing the National Inpatient Sample (NIS) database, this retrospective cohort study included adult patients admitted with a principal diagnosis of heart failure. Coding for race and ethnicity in the NIS combines self-reported race and ethnicity provided by the data source into 1 data element ("RACE"). We compared the outcomes between various racial groups, focusing on mortality, the length of stay (LOS), hospital charges, and complications. Differences in the utilization of advanced therapies, including implantable cardiac defibrillators, cardiac resynchronization therapy (CRT), ventricular assist devices (VADs), and heart transplant, were also analyzed.

Results

Out of 1,107,860 patients hospitalized with heart failure, 715,345 (64.57%) patients were White, 244,394 (22.06%) patients were Black, and 97,063 (8.31%) patients were Hispanic. Compared to White people, the odds of in-hospital mortality were lower among Black (aOR 0.74; 95% CI 0.68-0.81; p < 0.001) and Hispanic (aOR 0.78; 95% CI 0.69-0.88; p < 0.001) people. Complication rates including cardiogenic shock were found to be significantly lower in Black people (aOR 0.86; 95% CI 0.77-0.96; p < 0.001) and in Hispanic (aOR 0.72; 95% CI 0.63-0.81; p < 0.001) people. The rates of acute respiratory failure were also lower in Black (aOR 0.72; 95% CI 0.69-0.74; p < 0.001) and Hispanic (aOR 0.77; 95% CI 0.73-0.81; p < 0.001) people as opposed to White people. However, Black people were found to have higher rates of acute kidney injury (aOR 1.11; 95% CI 1.07-1.14; p < 0.001) and cardiac arrest (aOR 1.17; 95% CI 1.03-1.34; p = 0.02) compared to White people. Black people were less likely to receive advanced interventions, including cardiac resynchronization therapy (aOR 0.71; 95% CI 0.60-0.83; p < 0001), a ventricular assist device (aOR 0.45; 95% CI 0.34-0.59; p < 0.001), and heart transplants (aOR 0.57; 95% CI 0.42-0.77; p < 0.001), than White people. Hispanic people were found to have lower rates of ventricular assist device (aOR 0.49; 95% CI 0.33-0.72; p < 0.001) use than White people.

Conclusions

These findings highlight significant racial disparities in mortality, secondary outcomes, and advanced therapy utilization in heart failure admissions. Further research is needed to identify the root factors for these disparities in order to guide targeted interventions to reduce this racial gap.