BACKGROUND Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. RESULTS Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. CONCLUSIONS Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

中文翻译：

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在学术医学中心识别获得专科住院心力衰竭护理的种族不平等现象。

背景技术已经广泛地记录了心力衰竭（HF）患者的种族不平等。在住院期间接受心脏护理的心衰患者有更好的预后。尚不清楚种族对心脏病或普通医学服务的入院是否存在差异。这项研究检查了种族与入院服务之间的关系及其对30天再入院率和死亡率的影响方法：我们于2008年9月至2017年11月在一个大型城市学术转诊中心进行了一项回顾性队列研究，所有自我推荐的患者进入急诊科，并以心脏病的主要诊断为心脏病或普通医学服务，他们被自我识别为白人，黑人或拉丁裔。我们使用多变量广义估计方程模型来评估种族与心脏病服务准入之间的关系。我们使用Cox回归来评估种族，入院服务以及30天再入院率和死亡率之间的关联。结果在1967名独特患者中（白人占66.7％，黑人占23.6％，拉丁裔占9.7％），黑人和拉丁裔患者的心脏病学住院率低于白人（调整率，0.91； 95％CI，0.84-0.98） ，则表示黑色；调整后的比率为0.83； 95％可信区间为0.72-0.97（对于拉丁文）。性别和年龄大于75岁的女性也独立地与降低心脏科服务的住院率相关。心脏病患者的入院与30天内再次入院的减少独立相关，与种族无关。结论黑人和拉丁裔患者因心力衰竭接受心脏病学的可能性较小。这种不平等可能会部分导致HF结果中的种族不平等。