National Healthcare Disparities Report - LDI Health Economist

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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
Effectiveness of Care Outcome: Hospitalization for Congestive Heart Failure Congestive heart failure is the most frequent discharge diagnosis for Medicare beneficiaries. Some hospitalizations for heart failure are unavoidable, but rates of hospitalization can be influenced by the quality of outpatient care. Figure 2.9. Admissions for congestive heart failure per 100,000 population, age 18 and over, by race/ethnicity and area income, 2001-2008 Admissions per 100,000 Population 1500 1350 1200 1050 900 750 600 450 300 150 White Black Hispanic API 2008 Achievable Benchmark: 195 Admissions per 100,000 Population 1500 1350 1200 1050 900 750 600 450 300 150 Q1 (Lowest) Q2 Q3 Q4 (Highest) 2008 Achievable Benchmark: 195 Chapter 2 Cardiovascular Disease 0 2001 2002 2003 2004 2005 2006 2007 2008 0 2001 2002 2003 2004 2005 2006 2007 2008 Key: API = Asian or Pacific Islander; Q1 represents the lowest income quartile and Q4 represents the highest income quartile based on the median income of a patient’s ZIP Code of residence. Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, State Inpatient Databases disparities analysis file, and AHRQ Quality Indicators modified version 4.1, 2001-2008. Denominator: U.S. resident population age 18 and over. Note: For this measure, lower rates are better. Rates are adjusted by age and gender. White, Black, and API groups are non-Hispanic; Hispanic includes all races. n From 2004 to 2008, the overall rate of admissions for congestive heart failure decreased significantly overall and for each racial/ethnic and area income group (Figure 2.9). n In all years, Blacks had higher rates while APIs had lower rates of admission for congestive heart failure compared with Whites. n In all years, residents of the highest income quartile neighborhood had lower rates than residents of the three lower income quartile neighborhoods. n The 2008 top 4 State achievable benchmark for congestive heart failure admissions was 195 per 100,000 population. xi Overall, this benchmark could be achieved in 10 years. n At current rates of improvement, Whites could achieve the benchmark in 8 years. Hispanics and APIs could achieve the benchmark sooner than Whites, while Blacks would require 14 years. Residents of the lowest income quartile would require 18 years while residents of other income quartiles could achieve the benchmark in 8 years. xi The top 4 States that contributed to the achievable benchmark are Colorado, Oregon, Utah, and Vermont. National Healthcare Disparities Report, 2011 63
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