ArticleJournal of racial and ethnic health disparities2025
Ethnic Disparities in Guideline-Directed Medical Therapy for Heart Failure: A Retrospective Cohort Study of Hispanics vs non-Hispanic Patients.
Article in Journal of racial and ethnic health disparities, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo assess ethnic disparities in 90-day outcomes among patients hospitalized with acute decompensated heart failure (ADHF), and in the use of guideline-directed medical therapy (GDMT) among those with heart failure with reduced ejection fraction (HFrEF).
methodsThis retrospective cohort study included patients hospitalized with ADHF at a medium-sized health system between January 2018 and May 2024. Primary outcomes were 90-day mortality and readmission. Among patients with HFrEF, GDMT use was assessed as a secondary outcome. Multilevel logistic regression was used to evaluate associations between ethnicity and outcomes.
resultsA total of 14,644 patients with ADHF were included. No significant differences were observed in 90-day mortality (OR 0.69, 95% CI 0.21-2.24, P = 0.540) or 90-day readmission (OR 0.78, 95% CI 0.51-1.19, P = 0.267) between Hispanic and non-Hispanic patients. Among HFrEF patients, Hispanic patients had higher odds of receiving beta blockers (OR 1.32, 95% CI 1.04-1.68, p = 0.023), mineralocorticoid receptor antagonists (OR 1.37, 95% CI 1.05-1.79, p = 0.021), and renin-angiotensin system blockers (OR 1.51, 95% CI 1.17-1.95, p = 0.002). In contrast, no significant difference was observed in the use of sodium-glucose cotransporter-2 inhibitors between the two groups (OR 1.67, 95% CI 0.69-4.05, p = 0.254). Additionally, patients with Medicare (OR 0.65, 95% CI 0.57-0.74, p < 0.001) or unspecified insurance (OR 0.18, 95% CI 0.11-0.28, p < 0.001) had lower odds of receiving GDMT compared to self-pay patients.
conclusionThis study reveals a counterintuitive pattern of higher GDMT use among Hispanic HFrEF patients, underscoring the need to leverage community-based resources and patient assistance programs to address disparities. Further prospective studies are needed to confirm these findings or policy changes to reduce insurance-related barriers to GDMT.
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