Does aggregating Asian patients with heart failure put them in danger of receiving subpar care? A new study, published in the Journal of the American College of Cardiology (JACC), suggests it might.

For instance, the study showed particularly noteworthy gaps in care among Vietnamese men and Filipina women.

Among patients with heart failure with reduced ejection fraction, Vietnamese men had 32% lower adjusted odds of being discharged on fully optimized guideline-directed medical therapy, and Filipina women were 48% less likely to receive defect-free care than non-Hispanic White patients.

Both subgroups also had significantly shorter hospital stays: Vietnamese men and Filipina women were 32% and 34% less likely, respectively, to remain hospitalized beyond 4 days. This finding raises concern that discharge may have occurred before full optimization of therapy and patient education, the researchers noted.

Notably, in-hospital mortality did not differ significantly across Asian subgroups compared with non-Hispanic White patients, suggesting that disparities were driven by differences in care delivery rather than acute survival.

Significant Findings

Researchers examined patients across more than 800 hospitals in the United States between 2015 and 2023 and compared them with 768,566 non-Hispanic White patients, all of whom were hospitalized for heart failure. 

Investigators assessed key quality-of-care metrics, including:

• Discharge on guideline-directed medical therapy, defined as concurrent prescription of an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor; a beta-blocker; and a mineralocorticoid receptor antagonist
• Receiving defect-free care, defined as a composite of optimal medical therapy, heart-failure education, and follow-up scheduling
• Length of hospital stay

The study population included 7261 Asian patients with identified ethnic subgroup data. Subgroups were broken down into Asian Indian, Chinese, Filipino/Filipina, Japanese, Korean, Vietnamese, and “other Asian.”

This last subgroup included more than 21,000 additional patients in the registry who were classified only as “Asian,” without subgroup identification. In an editorial accompanying the most recent JACC study, Andy Y. Lee, MD, an assistant clinical professor at UCIrvine and a board-certified heart failure cardiologist, noted that these patients highlight a persistent systemic failure of healthcare databases to capture the diversity of Asian American populations — despite federal standards for disaggregating Asian subgroup data having been issued in 2011.

A History of Disparity

Disparities among Asian subgroups have a clear historical context. Only 0.17% of National Institutes of Health research funding between 1992 and 2018 included Asian American populations, despite Asian Americans being the fastest-growing racial group in the United States.

Across the 14 largest cardiovascular cohorts supported by the National Heart, Lung, and Blood Institute, Asian American, Native Hawaiian, and Pacific Islander individuals comprised only about 2% of nearly 245,000 participants, dramatically limiting statistical power for subgroup-specific cardiovascular analyses.

Lee’s editorial urged healthcare providers and researchers to recognize Asian Americans as heterogeneous populations.

“The disaggregation of Asian American research data is essential to understand the drivers of intragroup heterogeneity in appropriate heart failure treatment, and ultimately, to formulate actionable policy and clinical interventions in promoting equity for all,” he wrote.

Where Do We Go From Here?

One of the study authors, Nilay S. Shah, MD, MPH, offered speculation on the drivers behind the differences observed in the study.

“There are several potential factors that may include the level of English language proficiency or socioeconomic status, including insurance coverage. Whether or not cultural factors play a role, like norms related to healthcare or taking medication, also remains to be investigated,” said Shah, an assistant professor of cardiology, preventive medicine, and medical social sciences at Northwestern University Feinberg School of Medicine in Chicago.

One important step toward appropriate disaggregation of research data starts with recruiting for clinical studies and trials, according to Lee.

“Clinical trials should incorporate explicit goals for racial and ethnic diversity to better reflect the populations that will ultimately receive these therapies,” he told Medscape Medical News. “Despite the global nature of many studies, Asian representation remains limited or inappropriately generalized.”

Lee noted that a number of factors will be necessary to overcome this problem.

“Improving participation will require targeted recruitment through community-based organizations, efforts to rebuild trust in medical institutions, mitigation of language barriers, and increased visibility of Asian investigators and participants in research,” he said. 

“Additionally, regulatory agencies such as the FDA could consider policies or guidance that promote adequate racial and ethnic representation in clinical trials for drug and device approval,” Lee said.

The study was supported in part by the National Heart, Lung, and Blood Institute, with a grant awarded to Shah.

Lee reported no relevant financial disclosures.