Longer Heart Failure Hospitalization for Minority Patients Is Not Associated With Improved Quality of Care

By Rebecca Araujo - Last Updated: January 12, 2023

In the United States, heart failure presents a substantial cost burden for the healthcare system, as well as a mortality burden on patients. To implement successful preventative strategies and reduce the impact of heart failure hospitalization, identifying disparities in hospitalization according to patient factors, including race and ethnicity, is critical. A study from Jimmy Zheng and colleagues, published in Circulation: Heart Failure, investigated differences in heart failure hospitalization length of stay (LOS) in a racially and ethnically diverse patient population.

“Reducing hospital LOS has been identified as an important lever for minimizing the burden of heart failure hospitalization, yet the impact of social and structural determinants of health on LOS has received little attention,” the study authors wrote. They sought to identify differences in LOS among minority patients with heart failure in the United States.

Investigating Trends in Heart Failure Care

For this study, the researchers utilized data from the Get With The Guidelines – Heart Failure Registry, from the American Heart Association (AHA). The registry includes data on in-hospital treatment for heart failure across the United States and the use of AHA guideline-directed care at discharge.

The investigators characterized hospital LOS in patients admitted for heart failure according to patient race/ethnicity, insurance status, and disposition. They adjusted for factors such as demographics, comorbidities, and clinical severity. Hierarchical mixed-effects modeling was utilized to assess the effects of hospital-level clustering on the length of hospitalization.

The population comprised 3,730 patients hospitalized for heart failure. The primary outcome was the association between LOS and discharge rates of guideline-directed medical therapy.

Longer Hospitalization for Minority Heart Failure Patients

According to their analysis, the investigators found that patient race and ethnicity were associated with statistically significant differences in LOS. After excluding inpatient deaths, the adjusted LOS according to patient race/ethnicity were:

  • Black patients: 5.72 days (95% confidence interval [CI], 5.62–5.82),
  • Hispanic: 5.94 days (95% CI, 5.79–6.08)
  • Indigenous American/Pacific Islander: 6.06 days (95% CI, 5.85–6.27)
  • Non-Hispanic White: 5.32 days (95% CI, 5.25–5.39).

The authors noted this distinction was primarily driven by differences in LOS among patients who were discharged to either hospice or a nursing facility. They noted that, “After accounting for variability between hospitals, associations of race/ethnicity with LOS either were attenuated or reversed in direction.” Therefore, differences between hospitals contributed to this disparity in LOS.

Is Longer LOS Associated with Care Quality?

Along with evaluating whether patient race and ethnicity were associated with LOS differences, the study authors sought to clarify whether this extended hospitalization was associated with the use of guideline-directed care for these patients. They assessed the use of guideline-directed medical therapy rates in minority patients compared with non-Hispanic White patients.

Overall, the researchers found no difference between racial or ethnic groups in the use of guideline-directed therapy at patient discharge, despite the longer LOS for Black, Hispanic, and Indigenous/Pacific Islander patients.

“Differences between hospitals drive LOS disparities across race/ethnicity. Longer LOS among Black, Hispanic, and Indigenous American/Pacific Islander patients was not associated with improved quality of care,” the authors summarized.


  1. Zheng J, Tisdale RL, Heidenreich PA, Sandhu AT. Disparities in Hospital Length of Stay Across Race and Ethnicity Among Patients With Heart Failure. Circ Heart Fail. 2022 Nov;15(11):e009362.
  2. Jackson SL, Tong X, King RJ, Loustalot F, Hong Y, Ritchey MD. National Burden of Heart Failure Events in the United States, 2006 to 2014. Circ Heart Fail. 2018 Dec;11(12):e004873.
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