Background:
Because little is known about Asian American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program.
Methods:
We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3,774 Asian Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program between January 1, 2005 and December 31, 2012. Baseline characteristics, achievement measures, composite “all-or-none” care (proportion receiving all eligible achievement measures), quality measures, in-hospital mortality, discharge to home, and length of stay were examined.
Results:
Relative to white patients, Asian American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency. At admission, they had higher heart rate, systolic blood pressure, B-type natriuretic peptide, serum creatinine, and blood urea nitrogen. Overall, Asian American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk , 0.88; 95% confidence interval , 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Asian American patients had lower unadjusted rate than white patients in terms of implantable cardioverter defibrillators (ICD) counseling (32.7% versus 48.1%) and ICD placed/prescribed at discharge (33.8% versus 50.6%). However, these differences were not statistically significant after risk adjustment for patient and hospital characteristics. Compared with white patients, Asian American patients had comparable in-hospital mortality, length of stay, and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11) (Table).
Conclusion:
Despite some differences in clinical profiles, Asian American HF patients receive very similar quality of care and have comparable or even better health outcomes than white patients. This study suggests that focusing on 2 specific quality measures might further improve HF care for Asian Americans.
Association of Electronic Health Record Use With Quality of Care and Outcomes in Heart Failure: An Analysis of Get With The Guidelines—Heart Failure
