Characteristics and outcomes in African American patients with decompensated heart failure.
BACKGROUND
Outcomes in patients with chronic heart failure vary by race. Racial differences in the characteristics and outcomes of patients with acute decompensated heart failure (ADHF) have not been well characterized. Therefore, we assessed race-related differences in presentation, treatment, in-patient experiences, and short-term mortality due to ADHF before and after accounting for known covariates.


METHODS
The Acute Decompensated Heart Failure National Registry database was analyzed to evaluate demographic and mortality differences in African American and white patients with ADHF entered into the database from its initiation in September 2001 to December 31, 2004. Stratified analyses by cause, age, left ventricular function, and history of heart failure subgroups were also conducted.


RESULTS
A total of 105,872 episodes of ADHF occurred in white patients and 29,862 occurred in African American patients. African American patients with ADHF were younger than white patients (mean [SD] age, 63.5 [15.4] vs 72.5 [12.5] years) and had lower mean left ventricular ejection fractions. The prevalence of hypertension, diabetes mellitus, and obesity was higher in African American patients. African American race was associated with lower in-hospital mortality after adjustment for known predictors (2.1% vs 4.5%; adjusted odds ratio [OR], 0.79; 95% confidence interval [CI], 0.72-0.87; P < .001). This association persisted for all age cohorts, was independent of the use of intravenous vasoactive drugs, and was especially present in African American patients in the nonischemic subgroup (adjusted OR, 0.74; 95% CI, 0.57-0.96) but not the ischemic subgroup (adjusted OR, 0.91; 95% CI, 0.76-1.09).


CONCLUSIONS
In ADHF, African American race is associated with lower in-hospital mortality compared with white race, despite certain indicators of increased disease severity.
University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Sandeep A
SA
Kamath
Mark H
MH
Drazner
Janet
J
Wynne
Gregg C
GC
Fonarow
Clyde W
CW
Yancy
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000704:Analysis of Variance; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D044383:Black People; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000208:ethnology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D001741:Black or African American
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors