Author + information
- Received December 10, 2017
- Accepted February 22, 2018
- Published online April 30, 2018.
- Khadijah Breathett, MD, MSa,∗ (, )
- Wenhui G. Liu, PhDb,
- Larry A. Allen, MD, MHSc,
- Stacie L. Daugherty, MD, MSPHc,
- Irene V. Blair, PhDd,
- Jacqueline Jones, PhD, RNe,
- Gary K. Grunwald, PhDb,f,
- Marc Moss, MDg,
- Tyree H. Kiser, PharmDg,h,
- Ellen Burnham, MDg,
- R. William Vandivier, MDg,
- Brendan J. Clark, MD, MSg,
- Eldrin F. Lewis, MD, MPHi,
- Sula Mazimba, MD, MPHj,
- Catherine Battaglia, PhD, RNb,k,
- P. Michael Ho, MD, PhDb,c,g and
- Pamela N. Peterson, MD, MSPHc,l
- aDivision of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona
- bVeteran Affairs Eastern Colorado Health Care System, Denver, Colorado
- cDivision of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- dDepartment of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
- eDepartment of Nursing, University of Colorado, Aurora, Colorado
- fDepartment of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- gDivision of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, University of Colorado, Aurora, Colorado
- hDepartment of Clinical Pharmacy, University of Colorado, Aurora, Colorado
- iDivision of Cardiology, University of Virginia Health System, Charlottesville, Virginia
- jDivision of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
- kUniversity of Colorado School of Public Health, Denver, Colorado
- lDivision of Cardiology, Denver Health Medical Center, Denver, Colorado
- ↵∗Address for correspondence:
Dr. Khadijah Breathett, University of Arizona College of Medicine, Sarver Heart Center, 1501 North Campbell Avenue, Tucson, Arizona 85724.
Objectives This study sought to determine whether the likelihood of receiving primary intensive care unit (ICU) care by a cardiologist versus a noncardiologist was greater for Caucasians than for African Americans admitted to an ICU for heart failure (HF). The authors further evaluated whether primary ICU care by a cardiologist is associated with higher in-hospital survival, irrespective of race.
Background Increasing data demonstrate an association between better HF outcomes and care by a cardiologist. It is unclear if previously noted racial differences in cardiology care persist in an ICU setting.
Methods Using the Premier database, adult patients admitted to an ICU with a primary discharge diagnosis of HF from 2010 to 2014 were included. Hierarchical logistic regression models were used to determine the association between race and primary ICU care by a cardiologist, adjusting for patient and hospital variables. Cox regression with inverse probability weighting was used to assess the association between cardiology care and in-hospital mortality.
Results Among 104,835 patients (80.3% Caucasians, 19.7% African Americans), Caucasians had higher odds of care by a cardiologist than African Americans (adjusted odds ratio: 1.42; 95% confidence interval: 1.34 to 1.51). Compared with a noncardiologist, primary ICU care by a cardiologist was associated with higher in-hospital survival (adjusted hazard ratio: 1.20, 95% confidence interval: 1.11 to 1.28). The higher likelihood of survival did not differ by patient race (interaction p = 0.32).
Conclusions Among patients admitted to an ICU for HF, African Americans were less likely than Caucasians to receive primary care by a cardiologist. Primary care by a cardiologist was associated with higher survival for both Caucasians and African Americans.
Dr. Breathett has received support from the American Heart Association (AHA) Strategically Focused Research Network (#16SFRN29640000); the National Institutes of Health (NIH) L60 MD010857; the NIH/NCATS Colorado Clinical and Translational Sciences Institute (ULI TR001082); the University of Colorado, Department of Medicine, Health Services Research Development Grant Award; and the University of Arizona Health Sciences, Strategic Priorities Faculty Initiative Grant. Dr. Allen has received grant funding from NIH (K23 HL105896), the Patient Centered Outcomes Research Institute (CDR-1310-06998), and the AHA (#16SFRN29640000); and has served as consultant for Janssen, Amgen, Boston Scientific, and Novartis. Dr. Daugherty has received grant funding from the National Heart, Lung, and Blood Institute (NHLBI) (K08 HL103776 and RO1 HL133343) and the AHA (#2515963). Dr. Blair has received grant funding from the NHLBI (RO1 HL133343) and the AHA (15SFDRN24180024). Dr. Vandivier has received grant funding from the Flight Attendant Medical Research Institute (CIA092054 and 150001F). Dr. Clark has received grant funding from the NIH (K23 AA021814). Dr. Ho has served as a consultant for the AHA and Janssen Inc. Dr. Peterson has received grant funding from the AHA. Contents are the authors’ sole responsibility and do not necessarily represent official NIH views. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 10, 2017.
- Accepted February 22, 2018.
- 2018 American College of Cardiology Foundation
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