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

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

来源：JACC-Heart Failure, 2018, 6(5): 413-420.

DOI：10.1016/j.jchf.2018.02.015

• critical care
• disparities
• hospitals
• race

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.

• 出版日期2018-5