Women, Black Adults Less Likely to Receive Heart Failure Diagnoses In Primary Care Settings

Women, Black adults and individuals with lower net worth are significantly more likely to receive a heart failure diagnosis in an acute care setting—such as hospitalization or the emergency room—than in a primary care setting, according to a study published in Circulation: Heart Failure. According to the investigators, this discrepancy remains even if the individual reported symptoms of heart failure during a routine outpatient health care appointment within the past 6 months.

“Patients diagnosed with heart failure in the emergency room or during inpatient hospitalization often have more advanced heart failure and complications with worse prognoses than individuals diagnosed with heart failure in a primary care setting,” said Alexander Sandhu, MD, MS, in a press release. “Since earlier recognition and treatment may prevent some of the serious complications and costs of heart failure, our analysis focused on evaluating whether heart failure is identified before the patient is in the emergency room or the hospital.”

The study was conducted using a national database of commercial insurance and Medicare Advantage health care claims from 2003-2019. The investigators evaluated whether patients with new incidence of heart failure were diagnosed in an outpatient or acute care setting, including nearly 1 million adults ages 18 years or older with a first-time heart failure diagnosis.

According to the investigators, 38% of patients with newly diagnosed heart failure received their diagnosis in an acute care setting. Further, 46% of those patients had symptoms of potential heart failure during a primary care clinic visit within the previous 6 months, including edema (15%), cough (12%), shortness of breath (11%), and chest pain (11%). These acute care diagnoses were more common among women than men, and also more common among Black adults compared to White adults. Additionally, individuals with a net worth below $25,000 had 39% higher odds of receiving heart failure diagnoses in an acute care setting.

These disparities persisted nationally, which suggests potential differences in either quality of care or local resource availability, according to the investigators. Previous research has also suggested that women and Black adults are less likely to be referred to a cardiologist or to promptly receive advanced heart failure treatment, despite the necessity of rapid treatment to reduce the progression of heart failure.

“Further research is needed to better understand the factors influencing these disparities,” Sandhu said in the release. “It is important to note that we only analyzed patients with health insurance, raising concerns that inequities may be even larger among people who are uninsured, marginally insured, or those who have less access to care.”

REFERENCE

Heart failure diagnoses may be missed in a primary care setting for women, Black adults [news release]. EurekAlert; July 27, 2021. Accessed July 27, 2021. https://www.eurekalert.org/news-releases/826204