In Reply: We agree with Ms FitzGerald that
our findings should not be construed to suggest that there are no racial disparities
in cardiovascular care, nor should they be perceived as a political means
of denigrating the objective of equity in health care. We conducted an objective
assessment of quality of care for heart failure during hospitalization using
accepted quality indicators for heart failure and mortality and readmission.
Nevertheless, we feel that FitzGerald's comments merit important qualifications.
First, in-hospital management of heart failure is often not standardized,
as demonstrated by the wide variations in quality of heart failure care.1 FitzGerald's assertion that similar care is administered
to all patients irrespective of race in the presence of objective protocols
is inconsistent with research documenting racial differences in treatment
of acute myocardial infarction2 and general
ambulatory care,3 both of which have evidence-based
clinical practice guidelines to guide patient care.
Rathore SS, Krumholz HM, Masoudi FA, Havranek EP. Neurochemical Aspects of Susceptibility to Depression—Reply. JAMA. 2003;290(10):1316. doi:10.1001/jama.290.10.1316-a
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