Jerry H Gurwitz1, David J Magid2, David H Smith3, Grace Hsu4, Sue Hee Sung4, Larry A Allen5, David D McManus6, Robert J Goldberg7, Alan S Go8. 1. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, and Reliant Medical Group, Worcester, Mass; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass; Department of Medicine, University of Massachusetts Medical School, Worcester, Mass. Electronic address: Jerry.Gurwitz@meyersprimary.org. 2. Institute for Health Research, Kaiser Permanente Colorado, Denver. 3. Center for Health Research, Kaiser Permanente Northwest, Portland, Ore. 4. Division of Research, Kaiser Permanente Northern California, Oakland. 5. Colorado Cardiovascular Outcomes Research Consortium, Denver; University of Colorado School of Medicine, Aurora. 6. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, and Reliant Medical Group, Worcester, Mass; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass; Department of Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Mass. 7. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, and Reliant Medical Group, Worcester, Mass; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass. 8. Division of Research, Kaiser Permanente Northern California, Oakland; Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, Calif; Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, Calif.
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. METHODS: We identified all adults with heart failure with preserved ejection fraction between 2005 and 2008 from 4 health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses. RESULTS: Among 13,437 adults with confirmed heart failure with preserved ejection fraction, 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% confidence interval [CI], 0.62-0.85) and Asians (HR, 0.75; 95% CI, 0.64-0.87) had a 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 Asians (HR, 0.93; 95% CI, 0.85-1.02). CONCLUSIONS: In a diverse population with heart failure with preserved ejection fraction, 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.
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. METHODS: We identified all adults with heart failure with preserved ejection fraction between 2005 and 2008 from 4 health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses. RESULTS: Among 13,437 adults with confirmed heart failure with preserved ejection fraction, 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% confidence interval [CI], 0.62-0.85) and Asians (HR, 0.75; 95% CI, 0.64-0.87) had a 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 Asians (HR, 0.93; 95% CI, 0.85-1.02). CONCLUSIONS: In a diverse population with heart failure with preserved ejection fraction, 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.
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