title: Racial differences in the outcomes of patients with diastolic heart failure.
abstract: BACKGROUND
  More than half of all patients with congestive heart failure have preserved left ventricular systolic function. This is particularly common in African American patients, yet there have been few studies examining the long-term natural history of this disorder in African-American and white patients.
  
  
  METHODS
  We studied 2740 white and 563 African American patients with class II to IV symptoms and preserved systolic function (ejection fraction >40) identified in the Duke Cardiovascular Databank from 1984 to 1996. Unadjusted and adjusted 5-year survival rate comparisons were performed with Kaplan-Meier and Cox proportional hazards models, respectively.
  
  
  RESULTS
  The 5-year survival rates were 68% for African American patients and 70% for white patients (P =.55). However, after adjusting for known risk factors, African American patients had a significantly higher mortality risk than white patients (hazard ratio [HR], 1.34; 95% CI, 1.13-1.60). This racial difference in survival rate was most prominent in patients with a non-ischemic etiology (HR, 1.6; 95% CI, 1.2-2.0) as compared with patients with ischemic heart failure (HR, 1.1; 95% CI, 0.9-1.4).
  
  
  CONCLUSIONS
  Among patients with heart failure and preserved left ventricular systolic function, African American patients have a worse long-term prognosis than white patients. These results are important because of the prevalence of this condition in African American patients and their potential heterogeneous response to many heart failure therapies.
authors.affiliation: Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC 27715, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: East
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Gattis
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D001741:Black or African American; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume; D015996:Survival Rate; D016277:Ventricular Function, Left; D044465:White People