Racial Disparities in Type of Heart Failure and Hospitalization

Lee, Wei Chen; Serag, Hani; Ohsfeldt, Robert L.; Eschbach, Karl; Khalife, Wissam; Morsy, Mohamed; Smith, Kenneth D.; Raimer, Ben G.

doi:10.1007/s10903-018-0727-4

Cited by 13 publications

(17 citation statements)

References 20 publications

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“…HF and renal disease, 20,24,30 and 4 studies reported results for HFrEF or HFpEF subgroups. 17,27,30,33 No studies included in this review reported on the cost per hospitalization for the subgroup of patient with both HF and diabetes. 2).…”

Section: Figure 1 Prisma Diagrammentioning

confidence: 99%

“…17,25 Among studies reporting the distribution of primary insurance payer type, Medicare was the most frequently reported primary payer. The percentage of patients with Medicare as the primary payer ranged from 58% to 100% 17,19,22,25 ; the percentage with primary commercial coverage ranged from 7% to 17% 18,27 ; the percentage with primary Medicaid coverage ranged from 8% to 12% 5,27,32 ; and the percentage with primary private coverage ranged from 3% to 23%. 17,18 Among the studies that reported on the percentage of individuals who had key HF-related comorbidities, the percentage of patients with diabetes ranged from 29.0% to 47.9%, 5,25 with kidney disease from 0.2% to 55.7%, 18,29 with cerebrovascular disease from 1.0% to 13.5%, 25,33 with obesity from 14.3% to 21.0%, 16,33 and with hypertension from 18.3% to 81.3%.…”

Section: Figure 1 Prisma Diagrammentioning

confidence: 99%

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Burden of hospitalization for heart failure in the United States: a systematic literature review

Osenenko¹,

Kuti

Deighton³

et al. 2022

JMCP

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BACKGROUND: Heart failure (HF) affects approximately 6 million Americans, with prevalence projected to increase by 46% and direct medical costs to reach $53 billion by 2030. Hospitalizations are the largest component of direct costs for HF; however, recent syntheses of the economic and clinical burden of hospitalization for heart failure (HHF) are lacking. OBJECTIVE:To synthesize contemporary estimates of cost and clinical outcomes of HHF in the United States. METHODS:A systematic literature review was conducted using MEDLINE and Embase to identify articles reporting cost or charge per HHF in the United States published between January 2014 and May 2019. Subgroups of interest were those with both HF and renal disease or diabetes, as well as HF with reduced or preserved ejection fraction (HFrEF or HFpEF).RESULTS: 23 studies reporting cost and/or charge per HHF were included. Sample sizes ranged from 989 to approximately 11 million (weighted), mean age from 65 to 83 years, and 39% to 74% were male.

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confidence: 99%

Section: Figure 1 Prisma Diagrammentioning

confidence: 99%

Burden of hospitalization for heart failure in the United States: a systematic literature review

Osenenko¹,

Kuti

Deighton³

et al. 2022

JMCP

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“…African American patients are also shown to have a significantly higher readmission score but have a lower mortality score than white patients despite having a longer LOS and total charge. Lee et al noted similar findings of increase LOS and risk of readmission, however, there were no differences in cost or mortality [19]. It is difficult to speculate the reason for a longer LOS despite better outcomes and lower mortality score.…”

Section: Discussionmentioning

confidence: 80%

An Observation of Racial and Gender Disparities in Congestive Heart Failure Admissions Using the National Inpatient Sample

Tandon

Stringer

Conner

et al. 2020

Cureus

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Background Congestive heart failure (CHF) is a frequent cause of inpatient admissions in the United States. The purpose of this study was to analyze the racial and gender disparities that occur in CHF admissions and determine the impact of these disparities on medical expenditure. Methods We analyzed the National Inpatient Sample (NIS) database from 2009 to 2014 for patients with a primary discharge diagnosis of CHF, and further stratified the cohort on the basis of race and sex. Multivariate analysis was performed to identify the association between CHF and total charges along with other variables such as mortality, length of stay (LOS), and number of procedures. Results There were a total of 5,491,050 admissions with a primary diagnosis of CHF from 977,850 in 2009 to 901,425 in 2014. Females accounted for 49.7%. Total charges for CHF admission were highest in Asians at an average cost of $59,668. African Americans had the lowest mortality rate at 1.75%, however, they also had an average age of admission of 63.47 years, compared to Caucasian at 76.76 (p<0.05). Total charges for males were $42,920 and $36,744 for females (p <0.05). Males also had more procedures at 1.16 vs 0.98 for females (p <0.05). Elixhauser mortality score was higher in males than females at 5.95 vs 5.42 (p <0.05). Conclusion Healthcare disparities exist in CHF admissions in both contexts of race and gender. Further studies are required to pinpoint the source of these differences not only to address mortality but also expenditure costs.

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“…Further, in 1 in 9 deaths, HF is a contributing factor to mortality. Moreover, in one study with adult patients, racial differences were noted among young patients with HF (aged <50 years) [ 6 ]. More specifically, African Americans have a 20 times higher incidence rate of HF compared to that of White Americans [ 2 , 6 ], and among patients aged younger than 75 years, African Americans have the highest incidence of HF and often have an earlier age of HF onset [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, in one study with adult patients, racial differences were noted among young patients with HF (aged <50 years) [ 6 ]. More specifically, African Americans have a 20 times higher incidence rate of HF compared to that of White Americans [ 2 , 6 ], and among patients aged younger than 75 years, African Americans have the highest incidence of HF and often have an earlier age of HF onset [ 6 ]. The American Heart Association estimates that by 2030, there will be a 30% increase (from 2012) in the prevalence of HF among African Americans [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A Text Messaging–Enhanced Intervention for African American Patients With Heart Failure, Depression, and Anxiety (TXT COPE-HF): Protocol for a Pilot Feasibility Study

Cornelius¹,

Whitaker-Brown²,

Smoot³

et al. 2022

JMIR Res Protoc

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Background African Americans have a higher incidence rate of heart failure (HF) and an earlier age of HF onset compared to those of other racial and ethnic groups. Scientific literature suggests that by 2030, African Americans will have a 30% increased prevalence rate of HF coupled with depression. In addition to depression, anxiety is a predictor of worsening functional capacity, decreased quality of life, and increased hospital readmission rates. There is no consensus on the best way to treat patients with HF, depression, and anxiety. One promising type of treatment—cognitive behavioral therapy (CBT)—has been shown to significantly improve patients’ quality of life and treatment compliance, but CBT has not been used with SMS text messaging reminders to enhance the effect of reducing symptoms of depression and anxiety in racial and ethnic minority patients with HF. Objective The objectives of our study are to (1) adapt and modify the Creating Opportunities for Personal Empowerment (COPE) curriculum for delivery to patients with HF by using an SMS text messaging component to improve depression and anxiety symptoms, (2) administer the adapted intervention to 10 patients to examine the feasibility and acceptability of the approach and modify it as needed, and (3) examine trends in depression and anxiety symptoms postintervention. We hypothesize that patients will show an improvement in depression scores and anxiety symptoms postintervention. Methods The study will comprise a mixed methods approach. We will use the eight steps of the ADAPT-ITT (assessment, decision, administration, production, topical expert, integration, training, and testing) model to adapt the intervention. The first step in this feasibility study will involve assembling individuals from the target population (n=10) to discuss questions on a specific topic. In phase 2, we will examine the feasibility and acceptability of the enhanced SMS text messaging intervention (TXT COPE-HF [Texting With COPE for Patients With HF]) and its preliminary effects with 10 participants. The Beck Depression Inventory will be used to assess depression, the State-Trait Anxiety Inventory will be used to assess anxiety, and the Healthy Beliefs and Lifestyle Behavior surveys will be used to assess participants’ lifestyle beliefs and behavior changes. Changes will be compared from baseline to end point by using paired 2-tailed t tests. An exit focus group (n=10) will be held to examine facilitators and barriers to the SMS text messaging protocol. Results The pilot feasibility study was funded by the Academy for Clinical Research and Scholarship. Institutional review board approval was obtained in April 2021. Data collection and analysis are expected to conclude by November 2021 and April 2022, respectively. Conclusions The study results will add to the literature on the effectiveness of an SMS text messaging CBT-enhanced intervention in reducing depression and anxiety among African American patients with HF. International Registered Report Identifier (IRRID) PRR1-10.2196/32550

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Racial Disparities in Type of Heart Failure and Hospitalization

Cited by 13 publications

References 20 publications

Burden of hospitalization for heart failure in the United States: a systematic literature review

Burden of hospitalization for heart failure in the United States: a systematic literature review

An Observation of Racial and Gender Disparities in Congestive Heart Failure Admissions Using the National Inpatient Sample

A Text Messaging–Enhanced Intervention for African American Patients With Heart Failure, Depression, and Anxiety (TXT COPE-HF): Protocol for a Pilot Feasibility Study

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