Differences in initial severity of illness between black and white emergency department patients hospitalized with heart failure

Background Black patients hospitalized for heart failure have better reported short-term survival than white patients for unknown reasons. We sought to determine if initial severity of illness differed between black and white emergency department (ED) patients hospitalized for heart failure. Methods We analyzed 1,408 black and 7,260 white randomly selected patients in one state hospitalized from an ED during 2003 and 2004 and with a discharge diagnosis of heart failure. We used three validated clinical prediction rules to estimate severity of illness on admission. Results Black patients were younger than white patients (65.8 +/- 14.8 vs 77.4 +/- 11.5 years, P <.01) and were assigned to lower risk classes by all 3 prediction rules more frequently than white patients (P <.01). The odds ratio (95% Cl) for classification of black versus white patients into the lowest risk class within the three rules ranged from I. 16 (1.00-1.33) to 4.30 (3.75-4.94). After adjusting for hospital clustering, the odds ratio (95% Cl) for black versus white patient hospital death and complications was 0.75 (0.60-0.95) and, for 30-day death, was 0.34 (0.27-0.48). Conclusions Black ED patients hospitalized with heart failure are younger, less severely ill on admission and less likely to experience short-term fatal and nonfatal outcomes than white patients. Our findings suggest a varying opportunity between black and white patients when considering alternative initial treatment strategies and sites of care. (Am Heart J 2009; 157:306-11.)