An 8-year follow-up study of acute admissions with heart failure in a multiethnic population.
In 1994, we reported a cross-sectional survey of acute heart failure admissions to a city centre hospital serving a multiethnic population and found ethnic differences in aetiological factors and short-term (in-patient) mortality. We analysed long-term mortality data for this original survey cohort after 8 years' follow-up. At 8 years' follow-up, the total mortality was 90.5% amongst Europeans and 87.0% amongst non-Europeans (log rank test, P=0.0705). The non-European patients had significantly better survival at all time points until 6 years, after which the survival curves start to converge. In univariate analysis, age <75.6 years (that is, the median age of the whole cohort), use of beta-blockers, use of ACE inhibitors, and absence of atrial fibrillation were significantly associated with increased survival. In addition, patients who had had an echocardiographic examination had significantly prolonged survival when compared to those who did not. Using a Cox multiple regression analysis, age, renal impairment, atrial fibrillation, absence of echocardiography, absence of beta-blockers or ACE inhibitor use (and not ethnicity) remained significant predictors of mortality at 8 years. While this follow-up study has suggested that survival following admission for acutely decompensated heart failure is not different between different ethnic groups when corrected for age, it is clear from the younger age of heart failure patients from ethnic minority groups and the relatively high prevalence, that the burden of heart failure is greater in these populations. Future observational and therapeutic trials in heart failure should include sufficient numbers of participants from ethnic minority groups to ensure that the results can be applied to the population at risk.
University Department of Medicine, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham B18 7QH, UK.
Michael D
MD
Sosin
Gurbir S
GS
Bhatia
John
J
Zarifis
Russell C
RC
Davis
Gregory Y H
GY
Lip
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D015993:Life Tables; D008297:Male; D016016:Proportional Hazards Models; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors