Cohort study
Quality of Care and Clinical Outcomes for Patients With Heart Failure at Hospitals Caring for a High Proportion of Black Adults
- Retrospective cohort study
- registry-based (GWTG-HF)
Authors' conclusion
Quality of care for HF was similar across 11 of 14 measures at hospitals caring for high proportions of Black patients compared with other hospitals, as was overall defect-free HF care. There were no significant within-hospital differences in quality for Black patients vs White patients.
Study context
- Population
- Patients hospitalized for heart failure (HF) at GWTG-HF sites, 2016–2019
- Participants
- 422,483 patients · 480 hospitals
- Exposure
- Hospitals with high proportions of Black patients vs other hospitals
- High-proportion Black hospitalsn = 96
- Outcome
- Quality of HF care (14 evidence-based measures), overall defect-free HF care, and 30-day readmissions and mortality in Medicare patients
Main finding
As reported in the abstract
Overall defect-free HF care; 30-day outcomes (Medicare)
High-proportion Black hospitals vs Other hospitalsEstimate (95% CI)
overall defect-free HF care
OR 0.89(0.67–1.19)
30-day readmissions, risk-adjusted
HR 1.14(1.02–1.26)
30-day mortality
HR 0.92(0.84–1.02)
Observational data: associations, not effects.
Further findings
| Outcome | High-proportion Black hospitals | Other hospitals | Estimate | |
|---|---|---|---|---|
| ACEi/ARB/ARNI for LV systolic dysfunction | 92.7% | 92.4% | adjusted OR 0.91 (95% CI 0.65–1.27) | |
| Evidence-based β-blockers | 94.7% | 93.7% | OR 1.02 (95% CI 0.82–1.28) | |
| ARNI at discharge | 14.3% | 16.8% | OR 0.74 (95% CI 0.54–1.02) | |
| Anticoagulation for AF/flutter | 88.8% | 87.5% | OR 1.05 (95% CI 0.76–1.45) | |
| ICD counseling/placement/prescription at discharge | 70.9% | 71.0% | OR 0.75 (95% CI 0.50–1.13) | |
| Follow-up visit within ≤7 days at discharge | 70.4% | 80.1% | OR 0.68 (95% CI 0.53–0.86) | |
| CRT device placement/prescription | 50.6% | 53.8% | OR 0.63 (95% CI 0.42–0.95) | |
| Aldosterone antagonist | 50.4% | 53.5% | OR 0.69 (95% CI 0.50–0.97) | |
| 0.512Ratio (log scale) |
Within-hospital quality, Black vs White patients
- No significant within-hospital differences
Original publication
Quality of Care and Clinical Outcomes for Patients With Heart Failure at Hospitals Caring for a High Proportion of Black Adults. JAMA Cardiol. Published 1 June 2023. doi:10.1001/jamacardio.2023.0695
Summarised from the published abstract; every number is checked against it