期刊
JACC-HEART FAILURE
卷 6, 期 5, 页码 413-420出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.jchf.2018.02.015
关键词
critical care; disparities; hospitals; race
资金
- American Heart Association (AHA) Strategically Focused Research Network [16SFRN29640000]
- National Institutes of Health (NIH) [L60 MD010857]
- NIH/NCATS Colorado Clinical and Translational Sciences Institute [ULI TR001082]
- University of Colorado, Department of Medicine, Health Services Research Development Grant Award
- University of Arizona Health Sciences, Strategic Priorities Faculty Initiative Grant
- NIH [K23 HL105896, K23 AA021814]
- Patient Centered Outcomes Research Institute [CDR-1310-06998]
- AHA [16SFRN29640000, 2515963, 15SFDRN24180024]
- National Heart, Lung, and Blood Institute (NHLBI) [K08 HL103776, RO1 HL133343]
- NHLBI [RO1 HL133343]
- Flight Attendant Medical Research Institute [CIA092054, 150001F]
- AHA
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. (C) 2018 by the American College of Cardiology Foundation.
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