Division of Cardiology and the Cardiovascular Institute (A.T.S., F.R., P.A.H.), Stanford University, CA.
Palo Alto Veterans Affairs Healthcare System, CA (A.T.S., R.T., P.A.H.).
Circ Heart Fail. 2024 Oct;17(10):e011177. doi: 10.1161/CIRCHEARTFAILURE.123.011177. Epub 2024 Sep 18.
Disparities in guideline-based quality measures likely contribute to differences in heart failure (HF) outcomes. We evaluated between- and within-hospital differences in the quality of care across sex, race, ethnicity, and insurance for patients hospitalized for HF.
This retrospective analysis included patients hospitalized for HF across 596 hospitals in the Get With the Guidelines-HF registry between 2016 and 2021. We evaluated performance across 7 measures stratified by patient sex, race, ethnicity, and insurance. We evaluated differences in performance with and without adjustment for the treating hospital. We also measured variation in hospital-specific disparities.
Among 685 227 patients, the median patient age was 72 (interquartile range, 61-82) and 47.2% were women. Measure performance was significantly lower (worse) for women compared with men for all 7 measures before adjustment. For 4 of 7 measures, there were no significant sex-related differences after patient-level adjustment. For 20 of 25 other comparisons, racial and ethnic minorities and Medicaid/uninsured patients had similar or higher (better) adjusted measure performance compared with White and Medicare/privately insured patients, respectively. Angiotensin receptor neprilysin inhibitor measure performance was significantly lower for Asian, Hispanic, and Medicaid/uninsured patients, and cardiac resynchronization therapy implant/prescription was lower among women and Black patients after hospital adjustment, indicating within-hospital differences. There was hospital-level variation in these differences. For cardiac resynchronization therapy implantation/prescription, 278 hospitals (46.6%) had ≥2% lower implant/prescription for Black versus White patients compared with 109 hospitals (18.3%) with the same or higher cardiac resynchronization therapy implantation/prescription for Black patients.
HF quality measure performance was equitable for most measures. There were within-hospital differences in angiotensin receptor neprilysin inhibitor and cardiac resynchronization therapy implant/prescription for historically marginalized groups. The magnitude of hospital-specific disparities varied across hospitals.
基于指南的质量指标差异可能导致心力衰竭（HF）结局的差异。我们评估了性别、种族、族裔和保险在 HF 住院患者护理质量方面的医院间和医院内差异。
本回顾性分析纳入了 2016 年至 2021 年在 Get With the Guidelines-HF 注册中心的 596 家医院中因 HF 住院的患者。我们评估了按患者性别、种族、族裔和保险分层的 7 项措施的表现。我们评估了在调整和不调整治疗医院的情况下表现的差异。我们还测量了医院特定差异的变化。
在 685227 名患者中，中位患者年龄为 72 岁（四分位距，61-82 岁），47.2%为女性。在调整前，所有 7 项措施中，女性的表现均明显低于（更差）男性。在 7 项措施中的 4 项中，在患者水平调整后，性别之间没有显著差异。在 25 项其他比较中的 20 项中，与白人相比，少数族裔和医疗补助/无保险患者在 20 项其他比较中的种族和族裔以及医疗补助/无保险患者的调整后措施表现相似或更高（更好），而与医疗保险/私人保险患者相比，在血管紧张素受体脑啡肽酶抑制剂措施方面，亚裔、西班牙裔和医疗补助/无保险患者的表现明显较低，在医院调整后，女性和黑人患者的心脏再同步治疗植入/处方率较低，表明存在医院内差异。这些差异存在医院水平的差异。在心脏再同步治疗植入/处方方面，与白人患者相比，278 家（46.6%）医院黑人患者的植入/处方率低 2%或更多，而 109 家（18.3%）医院黑人患者的心脏再同步治疗植入/处方率相同或更高。
对于大多数措施，HF 质量措施的表现是公平的。在血管紧张素受体脑啡肽酶抑制剂和心脏再同步治疗植入/处方方面存在医院内差异，这些差异是历史上处于边缘地位的群体。医院间特定差异的幅度因医院而异。
