title: Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans.
abstract: BACKGROUND
  National statistics indicate that African Americans are disproportionately affected by mortality and hospitalizations resulting from heart failure when compared with other racial/ethnic groups. This might, in part, reflect a poorer course of heart failure among African Americans.
  
  
  METHODS
  We conducted a prospective cohort study of 316 white and 82 African American consecutive patients aged > or =50 years with decompensated heart failure on hospital admission. The outcome of the study was death or decline in activities of daily living function at 6 months relative to baseline.
  
  
  RESULTS
  African American patients were on average 8 years younger and had less favorable socioeconomic and access-to-care indicators. African Americans more often had a history of hypertension, renal insufficiency, and diabetes, but there were no differences in functional status, self-reported health status, signs of decompensation, or left ventricular ejection fraction. Quality-of-care indicators did not differ by race. Mortality rates at 6 months were similar in African Americans and whites (19.5% vs 17.2%, age adjusted), but African Americans had a greater functional decline (37.6% vs 24.7%). After adjusting for baseline characteristics, African Americans had an almost 50% higher risk of either death or decline in activities of daily living functioning (relative risk 1.45, 95% CI, 1.06-1.81). Adjustment for socioeconomic, access-to-care and quality-of-care indicators did not substantially change this estimate.
  
  
  CONCLUSIONS
  African Americans have similar mortality but greater functional decline than whites after hospitalization for heart failure. This outcome is not explained by clinical, socioeconomic, access-to-care or quality-of-care differences.
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga 30306, USA. lvaccar@emory.edu
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Evelyne
authors.initials: E
authors.lastname: Gahbauer
authors.forename: Stanislav V
authors.initials: SV
authors.lastname: Kasl
authors.forename: Peter A
authors.initials: PA
authors.lastname: Charpentier
authors.forename: Denise
authors.initials: D
authors.lastname: Acampora
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D044383:Black People; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D044465:White People; D001741:Black or African American