title: The complex relationship of race to outcomes in heart failure with preserved ejection fraction.
abstract: BACKGROUND
  An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians) in adults with heart failure with preserved ejection fraction.
  
  
  METHODS
  We identified all adults with heart failure with preserved ejection fraction between 2005 and 2008 from 4 health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses.
  
  
  RESULTS
  Among 13,437 adults with confirmed heart failure with preserved ejection fraction, 85.9% were white, 7.6% were black, and 6.5% were Asian. After adjustment for potential confounders and use of cardiovascular therapies, compared with whites, blacks (adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.62-0.85) and Asians (HR, 0.75; 95% CI, 0.64-0.87) had a lower risk of death from any cause. Compared with whites, blacks had a higher risk of hospitalization for heart failure (HR, 1.48; 95% CI, 1.29-1.68); no difference was observed for Asians compared with whites (HR, 1.01; 95% CI, 0.86-1.18). Compared with whites, no significant differences were detected in risk of hospitalization for any cause for blacks (HR, 1.03; 95% CI, 0.95-1.12) and Asians (HR, 0.93; 95% CI, 0.85-1.02).
  
  
  CONCLUSIONS
  In a diverse population with heart failure with preserved ejection fraction, we observed complex relationships between race and important clinical outcomes. More detailed studies of large populations are needed to fully characterize the epidemiologic picture and to elucidate potential pathophysiologic and treatment-response differences that may relate to race.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, and Reliant Medical Group, Worcester, Mass; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass; Department of Medicine, University of Massachusetts Medical School, Worcester, Mass. Electronic address: Jerry.Gurwitz@meyersprimary.org.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver.
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Ore.
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland.
authors.forename: Grace
authors.initials: G
authors.lastname: Hsu
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland.
authors.forename: Sue Hee
authors.initials: SH
authors.lastname: Sung
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, Denver; University of Colorado School of Medicine, Aurora.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, and Reliant Medical Group, Worcester, Mass; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass; Department of Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Mass.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, and Reliant Medical Group, Worcester, Mass; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland; Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, Calif; Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D044469:Racial Groups; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome
keywords: Heart failure; Hospitalization; Mortality; Preserved ejection fraction; Race