By Will Boggs MD

(Reuters Health) – African-Americans admitted to the intensive care unit (ICU) for heart failure are less likely than white patients to receive care by a cardiologist.

“It is important to realize that there are racial disparities in American healthcare,” Dr. Khadijah Breathett from the University of Arizona in Tucson told Reuters Health. “In order to receive equal access to care by a cardiologist, African-Americans need greater patient advocacy.”

African-Americans have a higher risk of heart failure and are more likely to die from heart failure than other races, but they are less likely to receive advanced therapies for heart failure.

Previous studies have shown that care by a cardiologist during hospital admissions for heart failure is associated with better outcomes, including higher survival rates, but it’s not clear whether this applies to patients in the ICU, too.

Breathett’s team used a nationwide database to study nearly 105,000 patients admitted to an ICU with heart failure. One in five were African-American; the rest were Caucasian. Most had some form of healthcare insurance.

Overall, the odds of being cared for primarily by a cardiologist were 42 percent higher for Caucasians than for African-Americans, the authors reported in JACC: Heart Failure.

After accounting for differences in heart failure severity and hospital characteristics, care from a cardiologist was associated with 20 percent higher survival rates, regardless of whether the patient was Caucasian or African-American.

“I hoped that this would be a negative study, demonstrating no racial differences in receipt of cardiology care based upon race,” Breathett said. “However, I suspected that racial differences would be present in this contemporary cohort since racial disparities persist in the incidence of heart failure, treatment of heart failure, and survival after developing heart failure.”

“I hope that this study motivates patients and healthcare providers to change our healthcare system, to focus on methods that may reduce racial and ethnic healthcare disparities in America,” she said.

Dr. Matthew Dupre from Duke Clinical Research Institute, Durham, North Carolina, who has also studied racial disparities in heart failure care but wasn’t involved in Breathett’s research, told Reuters Health, “On the one hand, it’s discouraging to see the persistence of racial differences in the receipt of specialized cardiovascular care, particularly in an intensive care setting. On the other hand, however, there is some encouraging news – that the racial gap in care has diminished in the last two decades, particularly in recent years after changes in health care policy.”

“Demonstrating these disparities is an important step to raise awareness of this issue,” he said by email. “However, more research is needed to understand the reasons for these disparities, why they’ve persisted, and how best to address them.”

SOURCE: Journal of the American College of Cardiology: Heart Failure, online April 30, 2018.