Variation by race in factors contributing to heart failure hospitalizations

Previous studies have shown a paradox of lower mortality in black compared with white patients after hospitalization for heart failure, in contrast to the overall higher mortality reported for nonhospitalized black patients with heart failure. We examined racial differences in factors contributing to hospitalization and in severity of illness in a cohort of black and white patients with heart failure who were hospitalized within a financially "equal access" health care system.

We performed a retrospective cohort study on 100 black or white male veterans admitted with heart failure to a VA Medical Center (black, n=52; white, n=48). Severity of illness as measured by the APACHE II score, a generic severity score, was similar between black and white patients (P=.72). However, using a recently developed heart failure-specific risk score, we found that white patients had higher severity of illness (P=.03). White patients had a higher number of coexisting comorbidities than black patients (P=.01), while black patients more frequently had uncontrolled hypertension at the time of admission (P=.004). Nonclinical factors contributing to hospitalization-such as nonadherence with medications or diet, inadequate outpatient follow-up, poor social support, and substance abuse-were documented more frequently for black patients compared with white patients.

At the time of hospitalization for heart failure, black patients may have an overall lower burden of disease and may more frequently have heart failure exacerbation precipitated by nonclinical factors. These findings may partly account for better long-term survival after hospitalization in black patients compared with white patients.