Heart Failure Quality of Care Among Asian Patients in the United States

Xiaoning Huang; Mark D Huffman; Namratha R Kandula; Lucia C Petito; Anubha Agarwal; Clyde W Yancy; Gregg C Fonarow; Pardeep S Jhund; Matthew T Mefford; Kristi L Reynolds; Sadiya S Khan; Nilay S Shah

doi:10.1016/j.jacc.2025.10.070

Heart Failure Quality of Care Among Asian Patients in the United States

J Am Coll Cardiol. 2025 Dec 26:S0735-1097(25)10152-6. doi: 10.1016/j.jacc.2025.10.070. Online ahead of print.

Authors

Affiliations

¹ Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
² Department of Internal Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
³ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁴ Department of Internal Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA.
⁵ Division of Cardiology, University of California Los Angeles, Los Angeles, California, USA.
⁶ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom.
⁷ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
⁸ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
⁹ Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: nilay.shah@northwestern.edu.

PMID: 41532945
DOI: 10.1016/j.jacc.2025.10.070

Abstract

Background: Heart failure (HF) incidence varies among U.S. Asian populations.

Objectives: The goal of this study was to identify differences in quality of inpatient care among individual groups of Asian patients hospitalized with HF and compared with non-Hispanic White patients.

Methods: This study included 824 U.S. hospitals from the Get With The Guidelines-Heart Failure registry (2015-2023). It evaluated the odds of optimal medical therapy (OMT) (defined as an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker or angiotensin receptor-neprilysin inhibitor for those with an ejection fraction [EF] ≤40%; a beta-blocker for those with an EF ≤40%; and mineralocorticoid receptor antagonist for those with an EF ≤35%) at discharge for HF with reduced EF, and length of stay (LOS) >4 days, defect-free care (OMT, follow-up visit scheduling, HF education) at discharge, and in-hospital mortality among patients with any EF. The study cohorts included Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian vs non-Hispanic White patients.

Results: Among 7,261 Asian patients with individual Asian group identified (mean age range 69.9-78.8 years; 41%-51% female) vs 768,566 non-Hispanic White patients (mean age 74.6 years; 47% female), the odds of receiving OMT were lower in Vietnamese male patients (adjusted OR [aOR]: 0.68; 95% CI: 0.47-1.00). The odds of longer LOS (>4 days) were lower in Vietnamese male patients (aOR: 0.68; 95% CI: 0.50-0.91) and Filipina female patients (aOR: 0.66; 95% CI: 0.46-0.95). The odds of defect-free care were lower in Filipina female patients (aOR: 0.52; 95% CI: 0.34-0.82). In-hospital mortality did not differ compared with non-Hispanic White patients. Among female Asian patients, there was significant heterogeneity in frequency of LOS >4 days and defect-free care across individual Asian groups.

Conclusions: HF quality of care is heterogeneous, with substantial gaps in certain U.S. Asian groups compared with non-Hispanic White patients.

Keywords: Asian; disparities; heart failure; quality of care.