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Heart Failure Quality of Care Among Asian Patients in the United States
Xiaoning Huang1, Mark D Huffman2, Namratha R Kandula1
1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
Heart failure (HF) care quality varies significantly among Asian subgroups in the U.S. Certain Asian groups, like Vietnamese men and Filipina women, experienced lower odds of optimal medical therapy and defect-free care compared to non-Hispanic White patients.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Health Disparities
Background:
- Heart failure (HF) incidence demonstrates variability across different U.S. Asian populations.
- Understanding these disparities is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate and compare the quality of inpatient care for individual Asian patient groups hospitalized with HF against non-Hispanic White patients.
- Identify specific areas of care where disparities may exist.
Main Methods:
- Utilized data from 824 U.S. hospitals in the Get With The Guidelines-Heart Failure registry (2015-2023).
- Evaluated odds of optimal medical therapy (OMT), length of stay (LOS) >4 days, defect-free care, and in-hospital mortality.
- Compared outcomes for Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian patient groups against non-Hispanic White patients.
Main Results:
- Vietnamese male patients had lower odds of receiving OMT (aOR: 0.68) and shorter LOS >4 days (aOR: 0.68).
- Filipina female patients had lower odds of LOS >4 days (aOR: 0.66) and defect-free care (aOR: 0.52).
- In-hospital mortality did not significantly differ between Asian groups and non-Hispanic White patients, but significant heterogeneity in care quality was observed among female Asian subgroups.
Conclusions:
- Quality of HF care is not uniform across all U.S. Asian patient groups.
- Substantial gaps in care quality exist for specific Asian subgroups when compared to non-Hispanic White patients.
- Targeted interventions are needed to address these identified disparities in heart failure management.
Background:
Heart failure (HF) incidence varies among U.S. Asian populations.
Objectives:
The goal of this study was to identify differences in quality of inpatient care among individual groups of Asian patients hospitalized with HF and compared with non-Hispanic White patients.
Methods:
This study included 824 U.S. hospitals from the Get With The Guidelines-Heart Failure registry (2015-2023). It evaluated the odds of optimal medical therapy (OMT) (defined as an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker or angiotensin receptor-neprilysin inhibitor for those with an ejection fraction [EF] ≤40%; a beta-blocker for those with an EF ≤40%; and mineralocorticoid receptor antagonist for those with an EF ≤35%) at discharge for HF with reduced EF, and length of stay (LOS) >4 days, defect-free care (OMT, follow-up visit scheduling, HF education) at discharge, and in-hospital mortality among patients with any EF. The study cohorts included Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian vs non-Hispanic White patients.
Results:
Among 7,261 Asian patients with individual Asian group identified (mean age range 69.9-78.8 years; 41%-51% female) vs 768,566 non-Hispanic White patients (mean age 74.6 years; 47% female), the odds of receiving OMT were lower in Vietnamese male patients (adjusted OR [aOR]: 0.68; 95% CI: 0.47-1.00). The odds of longer LOS (>4 days) were lower in Vietnamese male patients (aOR: 0.68; 95% CI: 0.50-0.91) and Filipina female patients (aOR: 0.66; 95% CI: 0.46-0.95). The odds of defect-free care were lower in Filipina female patients (aOR: 0.52; 95% CI: 0.34-0.82). In-hospital mortality did not differ compared with non-Hispanic White patients. Among female Asian patients, there was significant heterogeneity in frequency of LOS >4 days and defect-free care across individual Asian groups.
Conclusions:
HF quality of care is heterogeneous, with substantial gaps in certain U.S. Asian groups compared with non-Hispanic White patients.
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