African Americans Are Less Likely to Receive Care by a Cardiologist During an Intensive Care Unit Admission for Heart Failure

Khadijah Breathett, Wenhui G. Liu, Larry A. Allen, Stacie L. Daugherty, Irene V. Blair, Jacqueline Jones, Gary K. Grunwald, Marc Moss, Tyree H. Kiser, Ellen Burnham, R. William Vandivier, Brendan J. Clark, Eldrin F. Lewis, Sula Mazimba, Catherine Battaglia, P. Michael Ho, Pamela N. Peterson

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Objectives: This study sought to determine whether the likelihood of receiving primary intensive care unit (ICU) care by a cardiologist versus a noncardiologist was greater for Caucasians than for African Americans admitted to an ICU for heart failure (HF). The authors further evaluated whether primary ICU care by a cardiologist is associated with higher in-hospital survival, irrespective of race. Background: Increasing data demonstrate an association between better HF outcomes and care by a cardiologist. It is unclear if previously noted racial differences in cardiology care persist in an ICU setting. Methods: Using the Premier database, adult patients admitted to an ICU with a primary discharge diagnosis of HF from 2010 to 2014 were included. Hierarchical logistic regression models were used to determine the association between race and primary ICU care by a cardiologist, adjusting for patient and hospital variables. Cox regression with inverse probability weighting was used to assess the association between cardiology care and in-hospital mortality. Results: Among 104,835 patients (80.3% Caucasians, 19.7% African Americans), Caucasians had higher odds of care by a cardiologist than African Americans (adjusted odds ratio: 1.42; 95% confidence interval: 1.34 to 1.51). Compared with a noncardiologist, primary ICU care by a cardiologist was associated with higher in-hospital survival (adjusted hazard ratio: 1.20, 95% confidence interval: 1.11 to 1.28). The higher likelihood of survival did not differ by patient race (interaction p = 0.32). Conclusions: Among patients admitted to an ICU for HF, African Americans were less likely than Caucasians to receive primary care by a cardiologist. Primary care by a cardiologist was associated with higher survival for both Caucasians and African Americans.

Original languageEnglish (US)
Pages (from-to)413-420
Number of pages8
JournalJACC: Heart Failure
Volume6
Issue number5
DOIs
StatePublished - May 2018
Externally publishedYes

Keywords

  • critical care
  • disparities
  • hospitals
  • race

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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