African Americans Are Less Likely to Receive Care by a Cardiologist During an Intensive Care Unit Admission for Heart Failure

JACC Heart Fail. 2018 May;6(5):413-420. doi: 10.1016/j.jchf.2018.02.015.


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.

Keywords: critical care; disparities; hospitals; race.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Black or African American / ethnology
  • Black or African American / statistics & numerical data*
  • Cardiologists / statistics & numerical data*
  • Critical Care / statistics & numerical data*
  • Female
  • Healthcare Disparities / ethnology
  • Heart Failure, Diastolic / ethnology
  • Heart Failure, Diastolic / mortality
  • Heart Failure, Diastolic / therapy*
  • Heart Failure, Systolic / ethnology
  • Heart Failure, Systolic / mortality
  • Heart Failure, Systolic / therapy*
  • Hospital Mortality
  • Hospitalization / statistics & numerical data
  • Hospitals, Rural / statistics & numerical data
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Retrospective Studies
  • United States / epidemiology