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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.

Although differences in . . . [Full Text of this Article]

Saif S. Rathore, MPH; Harlan M. Krumholz, MD, SM
Section of Cardiovascular Medicine
Department of Internal Medicine
Yale University School of Medicine
New Haven, Conn

Frederick A. Masoudi, MD, MSPH; Edward P. Havranek, MD
Division of Cardiology
Department of Medicine
Denver Health Medical Center
Denver, Colo

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