The Complex Relationship of Race to Outcomes in Heart Failure with Preserved Ejection Fraction

Journal Name: 
Am.J.Med.
Authors: 
Gurwitz,J.H.
Magid,D.J.
Smith,D.H.
Hsu,G.
Sung,S.H.
Allen,L.A.
McManus,D.D.
Goldberg,R.J.
Go,A.S.
Abstract: 
BACKGROUND: An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians) in adults with heart failure with preserved ejection fraction (HFpEF). METHODS: We identified all adults with HFpEF between 2005 and 2008 from four health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses. RESULTS: Among 13,437 adults with confirmed HFpEF, 85.9% were white, 7.6% were black, and 6.5% were Asian. After adjustment for potential confounders and use of cardiovascular therapies, compared with whites, blacks (adjusted hazard ratio [HR] 0.72, 95% CI: 0.62-0.85) and Asians (HR 0.75, 95% CI: 0.64-0.87) had lower risk of death from any cause. Compared with whites, blacks had a higher risk of hospitalization for heart failure (HR 1.48, 95% CI: 1.29-1.68); no difference was observed for Asians compared with whites (HR 1.01, 95% CI: 0.86-1.18). Compared with whites, no significant differences were detected in risk of hospitalization for any cause for blacks (HR 1.03, 95% CI: 0.95-1.12) and for Asians (HR 0.93, 95% CI: 0.85-1.02). CONCLUSION: In a diverse population with HFpEF, we observed complex relationships between race and important clinical outcomes. More detailed studies of large populations are needed to fully characterize the epidemiologic picture and to elucidate potential pathophysiologic and treatment-response differences that may relate to race
12
29
2014
Keywords: 
Adult, Ambulatory, Blacks, California, clinical, Colorado, community, Death, differences, electronic, epidemiology, Health, Heart, Heart Failure, history, hospital, Hospitalization, Massachusetts, medical, Medicine, Methods, population, primary care, Public Health, race, Research, Risk, San Francisco, system, therapy, understanding, Universities, Whites