With several studies documenting racial inequities in HF care and outcomes, but data lacking on whether differences exist in admission to a cardiology or general medicine service by race, Lauren Eberly, MD, MPH, and colleagues conducted a study to examine the relationship between race and admission service.
“We conducted a retrospective cohort study using the EMR system at our large, urban, academic referral center,” explains Dr. Eberly. “We identified all patients self-referred to the ED and admitted with a principal diagnosis of HF to either the general medicine or cardiology service. We found structural inequities at our institution in which patients with HF were admitted to a specialized cardiology service based on race, gender, and age. Black and Latinx patients had 16% and 19% lower unadjusted rates of admission to cardiology service of inpatient HF care, respectively. After adjustment for a variety of important demographic and clinical factors, these lower rates persisted, with Black and Latinx patients having 9% and 17% lower adjusted rates.” Female sex and being older than 75 were also independently associated with lower rates of admission to cardiology service.
Being seen by a cardiologist as an outpatient was also found to be a powerful predictor of where a patient would go once admitted. “This is another example of a structural driver leading to disparate outcomes,” says Dr. Eberly. “Black and Latinx patients were less likely to have an outpatient cardiologist, which was the strongest predictor of being admitted to a cardiology service. It is often easier to get a patient admitted to a cardiology service with limited beds if they are a patient of a known institutional cardiologist or if their cardiologist can advocate for them for appropriate admission. Many Black and Latinx patients get into a cycle of readmission to medicine and never are able to ‘cross over’ to cardiology care, and their health likely suffers. Accessing cardiology care in the outpatient setting is thus one example of both an upstream and downstream driver of inequitable outcomes, and is one of many potential targets to improve equity. We feel that our results demonstrate that structural racism and differential access to specialty care is a driver of these disparate outcomes.”
Dr. Eberly emphasize that clinicians are on the front lines, with a unique vantage point to identify and characterize inequities in care. “We want to emphasize that our results are in no way unique to HF or our institution,” she adds. “Clinicians must ask themselves daily how structural racism operates in their field and at their institution. We have the power to make important change.
Physician's Weekly Admin