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Published on: October 28, 2020
Outcomes by race and etiology of patients with left ventricular systolic dysfunction
Kevin L Thomas1, Mark A East, Eric J Velazquez
1The Duke University Medical Center, Durham, North Carolina, USA. thoma095@mc.duke.edu
Insights
Black patients with systolic heart failure showed worse survival than white patients, particularly those with non-ischemic causes. However, overall mortality and rehospitalization risks were similar between racial groups when considering heart failure etiology.
Area of Science:
- Cardiology
- Health Disparities Research
- Clinical Outcomes
Background:
- Previous research indicates disparities in long-term outcomes for Black versus White patients with systolic heart failure.
- The underlying causes for these observed racial differences in heart failure outcomes remain largely undetermined.
- Understanding these disparities is crucial for equitable healthcare and targeted interventions.
Purpose of the Study:
- To investigate the influence of race and the underlying cause (etiology) of heart failure on patient outcomes.
- To analyze differences in mortality, rehospitalization rates, and combined endpoints between Black and White patients with left ventricular systolic dysfunction.
- To determine if race is an independent predictor of adverse outcomes in patients with symptomatic systolic heart failure.
Main Methods:
- Retrospective analysis of 1,977 patients with New York Heart Association class II-IV symptoms and ejection fraction <40% who underwent cardiac catheterization.
- Utilized adjusted Cox's proportional hazards regression models to assess mortality, rehospitalization, and a composite endpoint.
- Stratified analyses by race and heart failure etiology (ischemic vs. non-ischemic) to identify specific risk factors.
Main Results:
- Black patients were younger, more likely to be female, and had higher rates of diabetes and hypertension compared to White patients.
- Black patients were less likely to have significant coronary artery disease identified via angiography.
- Race was not found to be an independent predictor of overall mortality; however, Black patients with non-ischemic heart failure demonstrated worse survival than White patients with the same etiology.
Conclusions:
- No significant racial differences in long-term mortality or rehospitalization were observed when considering all patients with symptomatic left ventricular systolic dysfunction.
- A significant finding was decreased survival among Black patients with a non-ischemic etiology of heart failure compared to White patients.
- These findings highlight the importance of considering heart failure etiology in understanding racial disparities in cardiovascular outcomes.
Abstract:
Previous studies have shown that blacks have worse long-term outcomes than whites who have systolic heart failure. The reasons for these racial differences remain unclear. We investigated the effect of race and etiology of heart failure on outcomes of patients who had left ventricular (LV) systolic dysfunction. We studied records of 1,977 patients (27% black) who underwent cardiac catheterization who had New York Heart Association class II to IV symptoms and a LV ejection fraction <40%. Adjusted Cox's proportional hazards regression models were examined for the end points of mortality, rehospitalization, and a composite of the 2. Black versus white patients were younger (median age 56 vs 63 years, p <0.01), more often were women (49% vs 33%, p <0.01), had diabetes (37% vs 31%, p = 0.02), and hypertension (75% vs 56%, p <0.01). Black patients were less likely to have significant coronary artery disease by angiography (41% vs 69%, p <0.01). Race was not an independent predictor of mortality (hazard ratio 1.09, 95% confidence interval 0.93 to 1.28, p = 0.27). After adjusted survival curves were stratified by race and etiology, the estimates indicated that among those patients who had nonischemic LV dysfunction, blacks appeared to have worse survival than whites. Thus, we found no racial differences in the long-term mortality risk of patients who had symptomatic LV systolic dysfunction. In conclusion, after stratifying by ischemic and nonischemic etiologies, we found decreased survival in blacks who had a nonischemic etiology compared with whites. There were no racial differences in rehospitalization between patients who had ischemic LV systolic dysfunction and those who did not.
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