National Healthcare Disparities Report - LDI Health Economist

Effectiveness of Care
Chapter 2 Cardiovascular Disease
Treatment: Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker for
Heart Failure
Heart failure occurs when the heart muscle is too weak to adequately pump blood for the body’s metabolic
needs. Such impairment can result in a lack of adequate blood flow to vital organs, including the brain,
kidney, and other organs, as well as a backup of fluid into the lungs. Often, heart failure is caused by damage
to the heart muscle from a heart attack, which can seriously weaken the left ventricle, the main pumping
chamber of the heart. Congestive heart failure is the most frequent discharge diagnosis for Medicare
beneficiaries. ACE inhibitors and ARBs have been found to improve survival and slow or prevent further loss
of the heart’s pumping ability.
Figure 2.8. Hospital patients with heart failure and left ventricular systolic dysfunction prescribed ACE
inhibitor or ARB at discharge, by race/ethnicity, 2005-2009
Percent
100
95
90
Total
White
Black
Hispanic
2009 Achievable Benchmark: 96%
Asian
AI/AN
85
80
75
Z
0
2005
2006
2007
2008
2009
Key: ACE = angiotensin-converting enzyme; ARB = angiotensin
receptor blocker; AI/AN = American Indian or Alaska Native.
Source: Centers for Medicare & Medicaid Services, Medicare
Quality Improvement Organization Program, 2005-2009.
Denominator: Patients hospitalized with a principal diagnosis of
acute heart failure and left ventricular systolic dysfunction.
Note: White, Black, AI/AN, and Asian groups are non-Hispanic;
Hispanic includes all races.
n From 2005 to 2009, the overall percentage of patients with heart failure and left ventricular systolic
dysfunction prescribed ACE inhibitor or ARB at discharge increased from 83% to 94% (Figure 2.8).
Improvements were observed among all racial/ethnic groups.
n In all years, Blacks were more likely than Whites to receive ACE inhibitor or ARB at discharge.
n The 2009 top 5 State achievable benchmark for patients with heart failure and left ventricular
systolic dysfunction prescribed ACE inhibitor or ARB at discharge was 96%. x
n At current rates of improvement, all racial/ethnic groups could attain the benchmark within 3 years.
Also, in the NHQR:
n From 2005 to 2009, patients age 65 and over were less likely to receive ACE inhibitors or ARBs for
heart failure than patients under age 65.
x
The top 5 States that contributed to the achievable benchmark are Alaska, Idaho, Maine, New Hampshire, and Nevada.
62 National Healthcare Disparities Report, 2011