Disparity of care in the acute care of patients with heart failure

Deborah B. Diercks, Sean P. Collins, Brian Hiestand, James D Kirk, Michael C. Kontos, Christian Mueller, Richard Nowak, Alan Maisel, W. Frank Peacock

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)15-21
Number of pages7
JournalAcademic Emergency Medicine
Volume18
Issue number1
DOIs
StatePublished - Jan 2011

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Patient Care
Heart Failure
African Americans
Hospital Emergency Service
Odds Ratio
Confidence Intervals
Diuretics
Therapeutics
Technology
Nitroglycerin
Routine Diagnostic Tests
Nitrates
Outpatients
Logistic Models
Regression Analysis
Demography

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Diercks, D. B., Collins, S. P., Hiestand, B., Kirk, J. D., Kontos, M. C., Mueller, C., ... Frank Peacock, W. (2011). Disparity of care in the acute care of patients with heart failure. Academic Emergency Medicine, 18(1), 15-21. https://doi.org/10.1111/j.1553-2712.2010.00950.x

Disparity of care in the acute care of patients with heart failure. / Diercks, Deborah B.; Collins, Sean P.; Hiestand, Brian; Kirk, James D; Kontos, Michael C.; Mueller, Christian; Nowak, Richard; Maisel, Alan; Frank Peacock, W.

In: Academic Emergency Medicine, Vol. 18, No. 1, 01.2011, p. 15-21.

Research output: Contribution to journalArticle

Diercks, DB, Collins, SP, Hiestand, B, Kirk, JD, Kontos, MC, Mueller, C, Nowak, R, Maisel, A & Frank Peacock, W 2011, 'Disparity of care in the acute care of patients with heart failure', Academic Emergency Medicine, vol. 18, no. 1, pp. 15-21. https://doi.org/10.1111/j.1553-2712.2010.00950.x
Diercks, Deborah B. ; Collins, Sean P. ; Hiestand, Brian ; Kirk, James D ; Kontos, Michael C. ; Mueller, Christian ; Nowak, Richard ; Maisel, Alan ; Frank Peacock, W. / Disparity of care in the acute care of patients with heart failure. In: Academic Emergency Medicine. 2011 ; Vol. 18, No. 1. pp. 15-21.
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