Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center
Authors: Eberly Lauren A. , Richterman Aaron , Beckett Anne G. , Wispelwey Bram , Marsh Regan H. , Cleveland Manchanda Emily C. , Chang Cindy Y. , Glynn Robert J. , Brooks Katherine C. , Boxer Robert , Kakoza Rose , Goldsmith Jennifer , Loscalzo Joseph , Morse Michelle , Lewis Eldrin F. ,   On Behalf of the Brigham and Women’s Internal Medicine Housestaff‡, Abel Samantha , Adams Ayrenne , Anaya Joseph , Andrews Erik H , Atkinson Benjamin , Avutu Viswatej , Bachorik Alexandra , Badri Omar , Bailey Mariel , Baird Katie , Bakshi Salina , Balaban Denis , Barshop Kenneth , Baumrin Emily , Bayomy Omar , Beamesderfer Julia , Becker Nora , Berg, David D. , , Berman Adam N. , Blum Steven M. , Boardman Alexander P. , Boden Kaeleen , Bonacci Robert A , Brown Sarah , Campbell Kirsti , Case Siobhan , Cetrone Emily , Charrow Alexandra , Chiang David , Clark Devin , Cohen Aaron J. , Cooper Alissa , Cordova Tomas , Cuneo C. Nicholas , de Feria Alsina Alejandro , Deffenbacher Karen , DeFilippis Ersilia M. , DeGregorio Geneva , Deutsch Aaron J. , Diephuis Bradford , Divakaran Sanjay , Dorschner Peter , Downing Nicholas , Drescher Caitlin , D’Silva Kristin M. , Dunbar Peter , Duong David , Earp Sarah , Eckhardt Christine , Elman Scott A. , England Ross , Everett Kay , Fedotova Natalie , Feingold-Link Tamara , Ferreira Mark , Fisher Herrick , Foo Patricia , Foote Michael , Franco Idalid , Gilliland Thomas , Greb Jacqueline , Greco Katherine , Grewal Sungat , Grin Benjamin , Growdon Matthew E. , Guercio Brendan , Hahn Cynthia K. , Hasselfeld Brian , Haydu Erika J , Hermes Zachary , Hildick-Smith Gordon , Holcomb Zachary , Holroyd Kathryn , Horton Laura , Huang George , Jablonski Stanley , Jacobs Douglas , Jain Nina , Japa Sohan , Joseph Richard , Kalashnikova Mariya , Kalwani Neil , Kang Daniel , Karan Abraar , Katz Joel T , Kellner Daniel , Kidia Khameer , Kim June-Ho , Knowles Scott M , Kolbe Laura , Kore Idil , Koullias Yiannis , Kuye Ifedayo , Lang Joshua , Lawlor Matthew , Lechner Melissa G. , Lee Ken , Lee Scott , Lee Zachary , Limaye Neha , Lin-Beckford Stephanie , Lipsyc Marla , Little Jessica , Loewenthal Julia , Logaraj Ranjani , Lopez Diana M , Loriaux Daniel , Lu Yi , Ma Kevin , Marukian Nareh , Matias Wilfredo , Mayers Jared R. , McConnell Ian , McLaughlin Michael , Meade Christina , Meador Catherine , Mehta Anish , Messenger Elizabeth , Michaelidis Constantinos , Mirsky Jacob , Mitten Emilie , Mueller Alisa , Mullur Jyotsna , Munir Amir , Murphy Emily , Nagami Ellen , Natarajan Abirami , Nsahlai Michelle , Nze Chijioke , Okwara Noreen , Olds Peter , Paez Rafael , Pardo Michael , Patel Siddharth , Petersen Alec , Phelan Laura , Pimenta Erica , Pipilas Daniel , Plovanich Molly , Pong Denise , Powers Brian W. , Rao Anita , Ramirez Batlle Haiyan , Ramsis Mattheus , Reichardt Anna , Reiger Sheridan , Rengarajan Michelle , Rico Stephanie , Rome Benjamin N. , Rosales Rachael , Rotenstein Lisa , Roy Alexis , Royston Sarah , Rozansky Hallie , Rudder Meghan , Ryan Christine E. , Salgado Sanjay , Sanchez, Pablo , Schulte Jennifer , Sekar Aswin , Semenkovich Nicholas , Shannon Evan , Shaw Neil , Shorten Andrew Ben , Shrauner William , Sinnenberg Lauren , Smithy James W. , Snyder Gregory , Sreekrishnan Anirudh , Stabenau Hans , Stavrou Eleni , Stergachis Andrew , Stern Robert , Stone Alexander , Tabrizi Shervin , Tanyos Sam , Thomas Cristina , Thun Haley , Torres-Lockhart Kristine , Tran An , Treasure Carolyn , Tsai Frederick D. , Tsaur Stephen , Tschirhart Evan , Tuwatananurak Justin , Venkateswaran Ramkumar V. , Vishnevetsky Anastasia , Wahl Lindsay , Wall April , Wallace Frances , Walsh Elisa , Wang Priscilla , Ward Heather B. , Warner Lindsay N. , Weeks Lachelle D. , Weiskopf Kipp , Wengrod Jordan , Williams Jessica N. , Winkler Marisa , Wong Jeffrey L. , Worster Devin , Wright Aileen , Wunsch Caroline , Wynter Jamila S. , Yarbrough Chase , Yau Wai-Ying , Yazdi Daniel , Yeh Jennifer , Yialamas Maria A. , Yozamp Nicholas , Zambrotta Marina , Zon Rebecca 
Published: October 2019

Background:
Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality

Methods:
We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality.

Results:
Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84–0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72–0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race.

Conclusions:
Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.