Trends, Outcomes, and Healthcare Disparities of Asian patients with Heart Failure and Advanced Chronic Kidney Disease

Background Data on outcomes and risk factors for Asian patients with advanced chronic kidney disease admitted for heart failure are limited. The purpose of this study was to investigate contemporary racial and socioeconomic disparities in Asian patients with advanced kidney disease admitted for heart failure exacerbation. Methods This was a retrospective cohort study that utilized data from the National Inpatient Sample between January 2016 and December 2020. Patients who had a primary diagnosis of HF and a concomitant diagnosis of advanced CKD were included. The primary outcome of interest was in-hospital mortality. Secondary outcomes include hospital cost, length of stay, and other clinical outcomes. Weighted multivariable logistic regression was used to adjust for comorbidities. Results A total of 186,431 admissions for heart failure exacerbation with advanced kidney disease were identified, of which 10.7% ( n = 20,006) were of Asian descent. Asian patients had the lowest prevalence of comorbidities compared with all other ethnicities. After adjusting for comorbidities, sex, and age, Whites (OR: 1.11; 95% CI 1.03 to 1.20; p<0.009) had higher odds of mortality, while Black (OR: 0.58; 95% CI 0.53 to 0.63; p< 0.001) and Hispanic patients (OR: 0.69; 95% CI 0.62 to 0.78; p< 0.001) had lower odds of mortality compared to Asian patients. Conclusion Despite recent efforts to address healthcare inequality, health disparities among Asian patients with HF and CKD remain. The significant difference in odds of mortality and complications, despite a lower comorbidity burden, indicates the importance of further research regarding the possible causality of such disparities.