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

Abstract

Heart failure (HF) incidence varies among U.S. Asian populations. 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. 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. 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. HF quality of care is heterogeneous, with substantial gaps in certain U.S. Asian groups compared with non-Hispanic White patients.