OBJECTIVES: We sought to examine the characteristics, quality of care, and clinical outcomes for a large cohort of African-American patients hospitalized with heart failure (HF) in centers participating in a quality improvement initiative. BACKGROUND: Heart failure in African Americans is characterized by variations in natural history, lesser response to evidence-based therapies, and disparate health care. We hypothesized that a performance improvement program will achieve similar adherence to quality measures in African Americans admitted with HF compared with non-African Americans. METHODS: The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry-based performance-improvement program includes a pre-specified 10% subgroup with 60- to 90-day follow-up. Data on quality of care measures and outcomes were analyzed for 8,608 African-American patients compared with 38,501 non-African-American patients. RESULTS: African Americans were significantly younger and more likely to receive evidence-based medications but less likely to receive discharge instructions and smoking cessation counseling. In multivariable analyses, African-American race was an independent predictor of lower in-hospital mortality (odds ratio 0.71; 95% confidence interval 0.57 to 0.87; p < 0.001) but similar hospital length of stay. After multivariable adjustment, post-discharge outcomes were similar for American-American and non-African-American patients, but African-American race was associated with higher angiotensin-converting enzyme inhibitor prescription and left ventricular function assessment; no other HF quality indicators were influenced by race. CONCLUSIONS: In the context of a performance-improvement program, African Americans with HF received similar or better treatment with evidence-based medications, less discharge counseling, had better in-hospital survival, and similar adjusted risk of follow-up death/repeat hospital stay.
OBJECTIVES: We sought to examine the characteristics, quality of care, and clinical outcomes for a large cohort of African-American patients hospitalized with heart failure (HF) in centers participating in a quality improvement initiative. BACKGROUND:Heart failure in African Americans is characterized by variations in natural history, lesser response to evidence-based therapies, and disparate health care. We hypothesized that a performance improvement program will achieve similar adherence to quality measures in African Americans admitted with HF compared with non-African Americans. METHODS: The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry-based performance-improvement program includes a pre-specified 10% subgroup with 60- to 90-day follow-up. Data on quality of care measures and outcomes were analyzed for 8,608 African-American patients compared with 38,501 non-African-American patients. RESULTS: African Americans were significantly younger and more likely to receive evidence-based medications but less likely to receive discharge instructions and smoking cessation counseling. In multivariable analyses, African-American race was an independent predictor of lower in-hospital mortality (odds ratio 0.71; 95% confidence interval 0.57 to 0.87; p < 0.001) but similar hospital length of stay. After multivariable adjustment, post-discharge outcomes were similar for American-American and non-African-American patients, but African-American race was associated with higher angiotensin-converting enzyme inhibitor prescription and left ventricular function assessment; no other HF quality indicators were influenced by race. CONCLUSIONS: In the context of a performance-improvement program, African Americans with HF received similar or better treatment with evidence-based medications, less discharge counseling, had better in-hospital survival, and similar adjusted risk of follow-up death/repeat hospital stay.
Authors: Robert J Mentz; Vera Bittner; Phillip J Schulte; Jerome L Fleg; Ileana L Piña; Steven J Keteyian; Gordon Moe; Anil Nigam; Ann M Swank; Anekwe E Onwuanyi; Meredith Fitz-Gerald; Andrew Kao; Stephen J Ellis; William E Kraus; David J Whellan; Christopher M O'Connor Journal: Am Heart J Date: 2013-07-12 Impact factor: 4.749
Authors: Keyur B Shah; Anit K Mankad; Adam Castano; Olakunle O Akinboboye; Phillip B Duncan; Icilma V Fergus; Mathew S Maurer Journal: Circ Heart Fail Date: 2016-06 Impact factor: 8.790
Authors: Jia-Rong Wu; Terry A Lennie; Marla J De Jong; Susan K Frazier; Seongkum Heo; Misook L Chung; Debra K Moser Journal: J Card Fail Date: 2009-12-11 Impact factor: 5.712
Authors: Deepak K Gupta; Amil M Shah; Davide Castagno; Madoka Takeuchi; Laura R Loehr; Ervin R Fox; Kenneth R Butler; Thomas H Mosley; Dalane W Kitzman; Scott D Solomon Journal: JACC Heart Fail Date: 2013-04 Impact factor: 12.035