Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans.
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.
Vaccarino
Viola
V
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga 30306, USA. lvaccar@emory.edu
Gahbauer
Evelyne
E
Kasl
Stanislav V
SV
Charpentier
Peter A
PA
Acampora
Denise
D
Krumholz
Harlan M
HM
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