PURPOSE: Currently, there is a plethora of literature describing the entity of disparities in cardiovascular care and outcomes according to race and/or gender. However, the effect of a heart failure disease management program (HFDM) on the outcome of mortality by race and/or gender in systolic heart failure (SHF) patients has not been well detailed. Our hypothesis is that a HFDM would reduce treatment bias and thus reflect the same outcomes, mainly mortality, by both race and gender.
METHODS: Data for 519 adult SHF patients followed in our HFDM in rural South Louisiana from March 1997 to May 2004 was reviewed. Demographic and insurance information was obtained from hospital administrative databases and mortality information was obtained through the Social Security Death Index. SHF was defined as clinical symptoms and EF < 40%. A proportional hazards model was constructed to estimate the risk of death and included age, race, gender, EF, NYHA class, medications, hemoglobin, QRS duration, and other comorbidities.
RESULTS: Sixty-four percent were male and 36% were African-American (AfA). By race and gender, 22% were AfA males, 14% were AfA females, 42% were caucasian males and 22% were caucasian females. The median annual income for the entire population was $11,800. There was no difference in either Ace inhibitor or beta blocker usage between groups. All groups had a 90% or greater usage of both of these medications.
CONCLUSION: In our population of indigent SHF patients followed in a HFDM, differences in the risk of mortality according to race or gender were not apparent, a finding very different from peer-reviewed data regarding mortality outcomes by race and gender in SHF not using HFDM. Whether this finding is related to processes of the HFDM itself, the case mix of patients, the lack of differences between cohorts regarding standard medications, or some other factor is yet to be determined.
CLINICAL IMPLICATIONS: HFDM should be considered as a treatment process for SHF were feasible, in addition to the usual standard care as detailed in evidence-based guidelines.
DISCLOSURE: Lee Arcement, No Financial Disclosure Information; No Product/Research Disclosure Information