Race and Improvements in the Use of Guideline-Recommended Therapies for Patients With Heart Failure: Findings From IMPROVE HF

Abstract

Race is associated with differences in use of guideline-recommended therapies for patients with heart failure (HF). To evaluate whether a practice-based performance improvement intervention is associated with similar improvements in evidence-based care for black, white, and race-undocumented patients. IMPROVE HF is a longitudinal evaluation of a performance improvement intervention on use of evidence-based therapies for outpatients with HF or prior myocardial infarction and left ventricular ejection fraction less than or equal to 35%. Data were available for 7605 patients. Changes in use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, aldosterone antagonist, cardiac resynchronization therapy, implantable cardioverter-defibrillator therapy, anticoagulant for atrial fibrillation, and HF education were analyzed by patient race (black, white, or undocumented/missing). Multivariate analyses identified variables independently associated with changes in each therapy. There were 686 black patients (9.0%) and 3238 white patients (42.6%), and race was undocumented for 3537 (46.5%). Baseline use of B-blockers and aldosterone antagonists was significantly higher in black patients than in the other 2 groups, and use of aldosterone antagonists and HF education was higher among black patients at 24 months. Postintervention use of 4 of 7 therapies increased equitably for the 3 groups, and treatment rates were similar between black and white patients for 5 of 7 individual quality measures. Improvements in care were independent of race. These findings offer some indication that race-based differences in delivery of evidence-based HF care may be decreasing in outpatient cardiology practices. Application of clinical decision support and performance feedback may facilitate equitable improvements in HF care in outpatient settings regardless of patient race. NCT00303979, wwwv.clinicaltrials.gov.