Minority heart failure patients may get less access to specialized ICUs
Heart failure patients who are black, Hispanic or female are less likely than others to be admitted to specialized cardiac units, a disparity that may help explain long-known racial and gender differences in heart failure outcomes, a new study suggests.
After reviewing 10 years of medical records at Harvard’s Brigham and Women’s Hospital in Boston, researchers found that compared to white patients, similarly-sick black patients were 9% less likely to be admitted to cardiac care units and Latinx patients were 17% less likely, according to the study published in Circulation: Heart Failure.
The researchers also found that women were 9% less likely than men and patients over age 75 were 15% less likely than younger patients to be admitted to cardiac units.
“Research has shown that structural inequities are pervasive throughout healthcare delivery systems and across many services,” two of the study authors, Dr. Lauren Eberly and Dr. Eldrin Lewis, said in an email. Lewis is an associate professor of medicine at the Harvard Medical School and Eberly is now a fellow in cardiovascular medicine at the University of Pennsylvania. (She was in training at Brigham and Women’s Hospital during the study).
“Biology is often erroneously blamed for disparate outcomes because clinicians, administrators, researchers, etc., are uncomfortable naming racism as the true culprit and because race is often erroneously defined as a biological risk factor rather than a risk marker,” Eberly and Lewis said. “Black and Latinx patients have barriers to accessing outpatient cardiology care as they are less likely to have an outpatient cardiologist at our institution. (Having a cardiologist) was the strongest predictor of admission to the inpatient cardiology service.”
The advantages of being admitted to a cardiology unit were clear from the medical charts. Admission to a unit that specialized in heart care was independently associated with a 15% lower rate of hospital readmission within 30 days of discharge.
To take a closer look at who was most likely to be admitted to the cardiac unit, the researchers reviewed the records from 1,967 patients who came to the teaching hospital’s emergency department with heart failure. Overall, 66.7% were white, 23.6% were black, 9.7% were Latinx and 49.8% were women.
After accounting for factors such as age, gender, heart failure features and chronic illnesses, the researchers found that black patients who were admitted to the general medicine service had a higher rate of death within 30 days than those who were admitted to the cardiology unit (3% versus less than 1%).
“Medicine is not dissimilar to the rest of society,” said Dr. Noah Moss, a heart failure specialist and medical director of the Mechanical Circulatory Support Program at the Mount Sinai Hospital in New York City. “There are inherent biases and differences in the way patients will seek care based on race and sex. (These researchers) provide pretty good evidence that racial disparities exist in medical care as well.”
The study does have limitations, Moss said. Chief among them is the fact that it is a retrospective study, he added, which means “it’s more thought provoking than providing hard data on the subject.”
Another limitation is that it reflects experience at just one hospital.
Moss would like to see the findings confirmed in other studies.
“That being said, I don’t argue with the conclusions,” he said. “I do believe racial disparities exist in medicine just as they do elsewhere in society.”