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Racial Disparities in Type of Heart Failure and Hospitalization

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Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Heart failure (HF) is one of the leading causes of hospitalization and readmissions. Our study aimed to examine racial disparities in heart failure patients including onset, mortality, length of stay (LOS), direct costs, and readmission rates. This is a secondary data analysis. We analyzed the risk-adjusted inpatient data of all patients admitted with HF to one health academic center. We compared five health outcomes among three racial groups (white, black, and Hispanic). There were 1006 adult patients making 1605 visits from 10/01/2011 to 09/30/2015. Most black patients were admitted in younger age than other racial groups which indicates the needs for more public health preventions. With risk adjustments, the racial differences in LOS and readmission rates remain. We stratified health outcomes by race/ethnic and type of HF. The findings suggest that further studies to uncover underlying causes of these disparities are necessary. Using risk-adjusted hospitalization data allows for comparisons of quality of care across three racial groups. The study suggests that more prevention and protection services are needed for African American patients with heart failure.

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References

  1. Roger V. Epidemiology of heart failure. Circ Res. 2013;113:646–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Centers for Disease Control and Prevention (CDC). Heart failure fact sheet. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm.

  3. American Heart Association. Heart disease and stroke statisticis-2016 update. https://circ.ahajournals.org/content/early/2015/12/16/CIR.0000000000000350.

  4. Ni H, Xu JQ. Recent trends in heart failure-related mortality: United States, 2000–2014. NCHS data brief, no 231. Hyattsville, MD: National Center for Health Statistics. http://www.cdc.gov/nchs/data/databriefs/db231.htm.

  5. Sharma A, Colvin-Adams M, Yancy CW. Heart failure in African Americans: disparities can be overcome. Clevel Clin J Med. 2014;81(5):301–11.

    Article  Google Scholar 

  6. National Heart, Lung, and Blood Institute. What is heart failure? https://www.nhlbi.nih.gov/health/health-topics/topics/hf.

  7. Center of Continuous Education at Cleveland Clinic. Diseases management: heart failure. 2017. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/heart-failure/.

  8. American Heart Association. Types of Heart Failure. 2017. http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Types-of-Heart-Failure_UCM_306323_Article.jsp#.WiBcHDdryVA.

  9. Medical Clinics. Pathophysiology of systolic and diastolic heart failure. 2017. http://www.medical.theclinics.com/article/S0025-7125(12)00123-X/abstract.

  10. Ashley EA, Niebauer J. Chapter 7: Heart failure. In: Cardiology explained. London, UK: Remedica. http://www.ncbi.nlm.nih.gov/books/NBK2218/.

  11. Borlaug BA, Redfield MM. Are systolic and diastolic heart failure overlapping or distinct phenotypes within the heart failure spectrum? Circulation. 2011;123:2006–14.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Davis A, et al. Cardiovascular health disparities. Med Care Res Rev. 2007;64(5 Suppl):29S–100S.

    Google Scholar 

  13. Graham G. Population-based approaches to understanding disparities in cardiovascular disease risk in the United States. Int J Gen Med. 2014;7:393–400.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Center to Eliminate Health Disparities (CEHD). Disparity documentation report and improvement plans. Galveston, TX: University of Texas Medical Branch. http://www.utmb.edu/hpla/health-disparities/publications.

  15. University of Utah. What is the University HealthSystem Consortium? Health care: a community to quality. http://healthcare.utah.edu/quality/consortium.php.

  16. ICD9Data.com Heart Failure 428. http://www.icd9data.com/2014/Volume1/390-459/420-429/428/default.htm.

  17. University HealthSystem Consortium. UHC risk adjustment methodology. Chicago, IL: UHC; 2014.

    Google Scholar 

  18. University HealthSystem Consortium. UHC clinical data base/resource manager user manual. Chicago, IL: UHC; 2015.

    Google Scholar 

  19. StataCorp LP. Generalized estimating equations: xtgee. http://www.stata.com/features/generalized-estimating-equations/.

  20. Escarce JJ, Kapur K. Chapter 10: access to and quality of health care. In: Tienda M, Mitchell F, editors. Hispanics and the future of America. Washington DC: National Academies Press; 2006.

    Google Scholar 

  21. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30–41.

    Article  PubMed  Google Scholar 

  22. Lan T, et al. Social determinants of cardiovascular diseases. Public Health Rev. 2012;33(2):601 – 22.

    Google Scholar 

  23. Melton KD, et al. Heart failure in Hispanic Americans: improving culture awareness. School of Nursing Faculty Publications of Purdue University. http://docs.lib.purdue.edu/cgi/viewcontent.cgi?article=1026&context=nursingpubs.

  24. Calvillo-King L, et al. Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. J Gen Intern Med. 2012;28(2):269–82.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rahimi K, et al. Risk prediction in patients with heart failure. JCHF. 2014;2(5):440–6.

    Google Scholar 

  26. Ross JS, et al. Statistical models and patient predictors of readmission for heart failure: a systematic review. Arch Intern Med. 2008;168(13):1371–86.

    Article  PubMed  Google Scholar 

  27. Yang H, et al. Clinical prediction of incident heart failure risk: a systematic review and meta-analysis. Open Heart. 2015;2(1):e000222.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gardetto NJ. Self-management in heart failure: where have we been and where should we go? J Multidiscip Healthc. 2011;4:39–51.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hubbard T, McNeill N. Improving medication adherence and reducing readmissions. http://www.nacds.org/pdfs/pr/2012/nehi-readmissions.pdf.

  30. Damiani G, et al. Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review. Clin Interv Aging. 2015;10:237–45.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Giamouzis G, et al. Hospitalization epidemic in patients with heart failure: risk factors, risk prediction, knowledge gaps, and future directions. J Card Fail. 2011;17(1):54–75.

    Article  PubMed  Google Scholar 

  32. Tschihashi M, et al. Medical and socioenvironmental predictors of hospital readmission in patients with congestive heart failure. Am Heart J. 2001;142(4):E7.

    Google Scholar 

  33. Desai AS, Stevenson LW. Re-hospitalization for heart failure: predict or prevent? Circulation (Special Report). 2012;126:501–6.

    Google Scholar 

  34. Voigt J, et al. A reevaluation of the costs of heart failure and its implications for allocation of health resources in the United States. Clin Cardiol. 2014;37(5):312–21.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Joint Commission. Specification manual for Joint Commission National Quality Core Measures. https://manual.jointcommission.org/releases/archive/TJC2010B/HeartFailure.html.

  36. Ranasinghe I, et al. Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study. PLOS Med. 2014;11(9):e1001737.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Yancy C, Strong M. The national history, epidemiology, and prognosis of heart failure in African Americans. http://www.medscape.com/viewarticle/468119.

  38. Centers for Medicare and Medicaid Services (CMS). Innovation models. https://innovation.cms.gov/initiatives/index.html#views=models.

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Acknowledgements

The researchers would like to express the deepest gratitude to the following departments that without their help, this project would not be possible: (1) University of Texas Medical Brach Office of the President-Waiver Operations, (2) Clinical Data Management, and (3) Office of Health Policy and Legislative Affairs.

Funding

The study received financial funding from Texas Medicaid 1115 Waiver (#094092602.1.9).

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Authors and Affiliations

  1. Office of Health Policy and Legislative Affairs, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0920, USA

    Wei-Chen Lee, Hani Serag, Kenneth D. Smith & Ben G. Raimer

  2. Department of Health Policy and Management, Texas A&M Health Science Center, College Station, TX, USA

    Robert L. Ohsfeldt

  3. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA

    Karl Eschbach

  4. Department of Internal Medicine-Cardiology, University of Texas Medical Branch, Galveston, TX, USA

    Wissam Khalife & Mohamed Morsy

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  1. Wei-Chen Lee
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  2. Hani Serag
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  3. Robert L. Ohsfeldt
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  4. Karl Eschbach
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  5. Wissam Khalife
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  7. Kenneth D. Smith
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  8. Ben G. Raimer
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Correspondence to Wei-Chen Lee.

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No conflict of interest or others exists.

Ethical Approval

The study has acquired the approval of Institutional Review Board (#16-0128) at University of Texas Medical Branch and has complied with all requirements for a secondary data analysis to protect privacy of health information.

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Lee, WC., Serag, H., Ohsfeldt, R.L. et al. Racial Disparities in Type of Heart Failure and Hospitalization. J Immigrant Minority Health 21, 98–104 (2019). https://doi.org/10.1007/s10903-018-0727-4

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  • DOI: https://doi.org/10.1007/s10903-018-0727-4

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