Racial and Ethnic Disparities in Referral to Outpatient Heart Failure Management at Hospital Discharge: A Get With The Guidelines Analysis
Background Black and Hispanic patients with heart failure (HF) have a higher risk of adverse clinical outcomes. Currently, it is unclear whether there are disparities in referral to outpatient HF management programs based on race and ethnicity. Methods and Results We used the American Heart Associat...
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| Language: | English |
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Wiley
2025-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.036900 |
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| author | Maggie Wang Xinwei He Kaylyn Crawford Yi‐An Ko Neal W. Dickert Shivani A. Patel Ambarish Pandey Ersilia M. DeFilippis Khadijah Breathett Rebecca Cogswell Clyde W. Yancy Gregg C. Fonarow Alanna A. Morris |
| author_facet | Maggie Wang Xinwei He Kaylyn Crawford Yi‐An Ko Neal W. Dickert Shivani A. Patel Ambarish Pandey Ersilia M. DeFilippis Khadijah Breathett Rebecca Cogswell Clyde W. Yancy Gregg C. Fonarow Alanna A. Morris |
| author_sort | Maggie Wang |
| collection | DOAJ |
| description | Background Black and Hispanic patients with heart failure (HF) have a higher risk of adverse clinical outcomes. Currently, it is unclear whether there are disparities in referral to outpatient HF management programs based on race and ethnicity. Methods and Results We used the American Heart Association GWTG‐HF (Get With The Guidelines‐Heart Failure) registry to examine 402 225 patients hospitalized for acute HF from January 1, 2010 to December 31, 2021. Logistic regression was used to examine the association of race and ethnicity with the likelihood of referral to outpatient HF management programs, adjusted for demographics, hospital characteristics, distressed community index score, comorbidities, and indicators of HF severity. Of the 402 225 patients hospitalized for acute HF during the study period (mean age 72 years, 47% female, 44% with ejection fraction <40%), 220 354 (55%) patients were referred to an outpatient HF management program at hospital discharge. In fully adjusted models, patients who self‐identified as Hispanic (odds ratio [OR], 0.87 [95% CI, 0.84–0.90]), Asian (OR, 0.74 [95% CI, 0.70–0.78]), and other (American Indian, Alaska Native, Hawaiian Native, or Pacific Islander, OR, 0.85 [95% CI, 0.82–0.89]) had a lower likelihood of referral to outpatient HF management programs than White patients. There were no differences in referral likelihood between Black and White patients. Conclusions In the GWTG‐HF registry, patients from minoritized racial and ethnic groups, aside from Black patients, were less likely than White patients to be referred to outpatient HF management programs after HF hospitalization. Addressing these differences in referral practices may improve HF outcomes in minoritized communities. |
| format | Article |
| id | doaj-art-a4f806d077874bc19e44e03a2f8cf2b7 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-a4f806d077874bc19e44e03a2f8cf2b72025-08-20T02:34:47ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-03-0114610.1161/JAHA.124.036900Racial and Ethnic Disparities in Referral to Outpatient Heart Failure Management at Hospital Discharge: A Get With The Guidelines AnalysisMaggie Wang0Xinwei He1Kaylyn Crawford2Yi‐An Ko3Neal W. Dickert4Shivani A. Patel5Ambarish Pandey6Ersilia M. DeFilippis7Khadijah Breathett8Rebecca Cogswell9Clyde W. Yancy10Gregg C. Fonarow11Alanna A. Morris12Department of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USADepartment of Biostatistics and Bioinformatics Emory University Rollins School of Public Health Atlanta GA USADepartment of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USADepartment of Biostatistics and Bioinformatics Emory University Rollins School of Public Health Atlanta GA USADepartment of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USAHubert Department of Global Health and Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA USADepartment of Medicine, Division of Cardiology University of Texas Southwestern Medical Center Dallas TX USADepartment of Medicine, Division of Cardiology New York Presbyterian‐Columbia University Irving Medical Center New York NY USADepartment of Medicine, Division of Cardiology Indiana University School of Medicine Indianapolis IN USADepartment of Medicine, Division of Cardiovascular Medicine University of Minnesota Minneapolis MN USADepartment of Medicine, Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL USADepartment of Medicine, Division of Cardiology, Ahmanson‐UCLA Cardiomyopathy Center University of California Los Angeles Medical Center Los Angeles CA USADepartment of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USABackground Black and Hispanic patients with heart failure (HF) have a higher risk of adverse clinical outcomes. Currently, it is unclear whether there are disparities in referral to outpatient HF management programs based on race and ethnicity. Methods and Results We used the American Heart Association GWTG‐HF (Get With The Guidelines‐Heart Failure) registry to examine 402 225 patients hospitalized for acute HF from January 1, 2010 to December 31, 2021. Logistic regression was used to examine the association of race and ethnicity with the likelihood of referral to outpatient HF management programs, adjusted for demographics, hospital characteristics, distressed community index score, comorbidities, and indicators of HF severity. Of the 402 225 patients hospitalized for acute HF during the study period (mean age 72 years, 47% female, 44% with ejection fraction <40%), 220 354 (55%) patients were referred to an outpatient HF management program at hospital discharge. In fully adjusted models, patients who self‐identified as Hispanic (odds ratio [OR], 0.87 [95% CI, 0.84–0.90]), Asian (OR, 0.74 [95% CI, 0.70–0.78]), and other (American Indian, Alaska Native, Hawaiian Native, or Pacific Islander, OR, 0.85 [95% CI, 0.82–0.89]) had a lower likelihood of referral to outpatient HF management programs than White patients. There were no differences in referral likelihood between Black and White patients. Conclusions In the GWTG‐HF registry, patients from minoritized racial and ethnic groups, aside from Black patients, were less likely than White patients to be referred to outpatient HF management programs after HF hospitalization. Addressing these differences in referral practices may improve HF outcomes in minoritized communities.https://www.ahajournals.org/doi/10.1161/JAHA.124.036900health disparitiesheart failureheart failure managementrace and ethnicityreferral |
| spellingShingle | Maggie Wang Xinwei He Kaylyn Crawford Yi‐An Ko Neal W. Dickert Shivani A. Patel Ambarish Pandey Ersilia M. DeFilippis Khadijah Breathett Rebecca Cogswell Clyde W. Yancy Gregg C. Fonarow Alanna A. Morris Racial and Ethnic Disparities in Referral to Outpatient Heart Failure Management at Hospital Discharge: A Get With The Guidelines Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease health disparities heart failure heart failure management race and ethnicity referral |
| title | Racial and Ethnic Disparities in Referral to Outpatient Heart Failure Management at Hospital Discharge: A Get With The Guidelines Analysis |
| title_full | Racial and Ethnic Disparities in Referral to Outpatient Heart Failure Management at Hospital Discharge: A Get With The Guidelines Analysis |
| title_fullStr | Racial and Ethnic Disparities in Referral to Outpatient Heart Failure Management at Hospital Discharge: A Get With The Guidelines Analysis |
| title_full_unstemmed | Racial and Ethnic Disparities in Referral to Outpatient Heart Failure Management at Hospital Discharge: A Get With The Guidelines Analysis |
| title_short | Racial and Ethnic Disparities in Referral to Outpatient Heart Failure Management at Hospital Discharge: A Get With The Guidelines Analysis |
| title_sort | racial and ethnic disparities in referral to outpatient heart failure management at hospital discharge a get with the guidelines analysis |
| topic | health disparities heart failure heart failure management race and ethnicity referral |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036900 |
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