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CLINICAL RESEARCH: HEART FAILURE

Quality of Care of and Outcomes for African Americans Hospitalized With Heart Failure

Findings From the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) Registry

Clyde W. Yancy, MD, FACC^_*,_*, William T. Abraham, MD, FACC, Nancy M. Albert, PhD, RN, Robert Clare, MS, Wendy Gattis Stough, PharmD^||,¶, Mihai Gheorghiade, MD, FACC^#, Barry H. Greenberg, MD, FACC^_**, Christopher M. O'Connor, MD, FACC, Lilin She, PhD, Jie Lena Sun, MS, James B. Young, MD, FACC and Gregg C. Fonarow, MD, FACC

^_* Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
Division of Cardiology, Ohio State University, Columbus, Ohio
George M. and Linda H. Kaufman Center for Heart Failure, Durham, North Carolina
Duke Clinical Research Institute, Durham, North Carolina
^|| Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, North Carolina
^¶ Department of Medicine, Duke University Medical Center, Durham, North Carolina
^# Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
^_** Department of Medicine, University of California San Diego Medical Center, San Diego, California
Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, California.

Manuscript received July 30, 2007; revised manuscript received January 24, 2008, accepted January 29, 2008.

^_* Reprint requests and correspondence: Dr. Clyde W. Yancy, Baylor Heart and Vascular Institute, Baylor University Medical Center, 3500 Gaston Avenue, Suite H-030, Dallas, Texas 75246. (Email: clydey{at}baylorhealth.edu).

Objectives: We sought to examine the characteristics, quality of care, and clinical outcomes for a large cohort of African-American patients hospitalized with heart failure (HF) in centers participating in a quality improvement initiative.

Background: Heart failure in African Americans is characterized by variations in natural history, lesser response to evidence-based therapies, and disparate health care. We hypothesized that a performance improvement program will achieve similar adherence to quality measures in African Americans admitted with HF compared with non–African Americans.

Methods: The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry-based performance-improvement program includes a pre-specified 10% subgroup with 60- to 90-day follow-up. Data on quality of care measures and outcomes were analyzed for 8,608 African-American patients compared with 38,501 non–African-American patients.

Results: African Americans were significantly younger and more likely to receive evidence-based medications but less likely to receive discharge instructions and smoking cessation counseling. In multivariable analyses, African-American race was an independent predictor of lower in-hospital mortality (odds ratio 0.71; 95% confidence interval 0.57 to 0.87; p < 0.001) but similar hospital length of stay. After multivariable adjustment, post-discharge outcomes were similar for American-American and non–African-American patients, but African-American race was associated with higher angiotensin-converting enzyme inhibitor prescription and left ventricular function assessment; no other HF quality indicators were influenced by race.

Conclusions: In the context of a performance-improvement program, African Americans with HF received similar or better treatment with evidence-based medications, less discharge counseling, had better in-hospital survival, and similar adjusted risk of follow-up death/repeat hospital stay. (Organized Program to Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure [OPTIMIZE-HF]; NCT00344513 [ClinicalTrials.gov] )

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   ACE = angiotensin-converting enzyme   ARB = angiotensin receptor blocker   BNP = B-type natriuretic peptide   CI = confidence interval   HF = heart failure   LVEF = left ventricular ejection fraction   LVSD = left ventricular systolic dysfunction   OR = odds ratio