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September 10, 2003

Neurochemical Aspects of Susceptibility to Depression—Reply

JAMA. 2003;290(10):1316. doi:10.1001/jama.290.10.1316-a

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.