Disclosures: The authors report no relevant financial disclosures.
July 27, 2021
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Chance for early HF diagnosis in a primary care setting missed for many women, Black patients

Disclosures: The authors report no relevant financial disclosures.
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Women and Black individuals are more likely to be diagnosed with HF in an acute care setting than a primary care setting compared men and white patients, respectively, according to data published in Circulation: Heart Failure.

Researchers also reported that low net worth and occupation status (“homemaker” or “retired”) were also associated with elevated odds of receiving a first HF diagnosis in an acute setting compared with a primary care setting.

Infographic describing groups missed in a primary care setting for early HF diagnosis.
Women and Black individuals are more likely to be diagnosed with HF in an acute care setting than a primary care setting compared men and white patients, respectively. Data were derived from:Sandhu A, et al. Circ Heart Fail. 2021;doi:10.1161/CIRCHEARTFAILURE.121.008538.

“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,” Alexander Sandhu, MD, MS, instructor of medicine in advanced heart failure in the division of cardiovascular medicine and the Stanford Cardiovascular Institute at Stanford University, said 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.”

Based on diagnostic codes from a large claims database, Sandhu and colleagues identified characteristics that predicted HF diagnosis in the acute care setting compared with the primary care setting.

Disparities in HF detection

Among nearly 1 million individuals who received a diagnosis of new HF between 2003 and 2019, approximately 38% were diagnosed in the acute setting. Of these patients, 46% may have been experiencing HF symptoms in the 6 months prior to their diagnosis.

Researchers reported that women more likely to receive a first HF diagnosis in an acute care setting compared with men (aOR = 1.11; 95% CI, 1.1-1.12) and Black individuals were more likely to be diagnosed in an acute setting compared with white individuals (aOR = 1.18; 95% CI, 1.16-1.19).

Researchers also reported that individuals with lower net worth were more like to receive a first HF diagnosis in the acute care setting compared with those with greater net worth (adjusted OR for net worth less than $25,000 vs. over $500,000 = 1.39; 95% CI, 1.36-1.41).

Patients whose occupation was categorized as “homemaker” or “retired” in the database were also more likely to be diagnosed with HF in the acute care setting compared with those who were marked as professionals (aOR = 1.04; 95% CI, 1.01-1.07).

According to the study, the proportion of women and men with a net worth of less than $25,000 and a HF diagnosis in the acute care setting was similar (42% vs. 41%); however, more women than men with a net worth greater than $500,000 were diagnosed in the acute care setting (36% vs. 32%). In addition, more Black patients with a first HF diagnosis in the acute care setting had net worth less than $25,000 compared with other races/ethnicities (46% of Black patients vs. 42% of white patients vs. 35% of Hispanic patients).

Among those linked to an outpatient clinician prior to first HF diagnosis, both women (aOR = 1.2; 95% CI, 1.19-1.22) and Black patients (aOR = 1.11; 95% CI, 1.09-1.13) were more likely to be diagnosed with HF in the acute setting than men and white patients, respectively.

These observations were consistent in spite of subsequent sensitivity analyses that adjusted for patients with a single HF diagnosis, patients without socioeconomic data and patients with cardiology visits between 6 months and 7 days prior to their first HF diagnosis.

HF diagnoses ‘missed’ in the primary care setting

“This national study raises concerns that many heart failure diagnoses may be missed in a primary care setting,” Rebecca Tisdale, MD, MPA, health services research and development fellow at the U.S. Department of Veterans Affairs and Stanford University, said in the release. “Our results suggest acute care diagnosis rates for heart failure may be reduced if signs and symptoms of heart failure are more closely assessed in a primary care setting, particularly among women and Black adults.”

“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.”