title: Racial differences in clinical treatment and self-care behaviors of adults with chronic heart failure.
abstract: BACKGROUND
  In the United States, the highest prevalence of heart failure (HF) is in blacks followed by whites. Compared with whites, blacks have a higher risk of HF-related morbidity and mortality and HF-related hospitalization. Little research has focused on explaining the reasons for these disparities. The purpose of this study was to examine racial differences in demographic and clinical characteristics in blacks and whites with HF and to determine if these characteristics influenced treatment, or together with treatment, influenced self-care behaviors.
  
  
  RESULTS
  This was a secondary analysis of existing data collected from adults (n=272) with chronic HF enrolled from outpatient sites in the northeastern United States and followed for 6 months. After adjusting for sociodemographic and clinical characteristics within reduced (HFrEF) and preserved ejection fraction (HFpEF) groups, there were 2 significant racial differences in clinical treatment. Blacks with HFrEF were prescribed ACE inhibitors and hydralazine and isosorbide dinitrate (H-ISDN) more often than whites. In the HFpEF group, blacks were taking more medications and were prescribed digoxin and a diuretic when symptomatic. Deficits in HF knowledge and decreased medication adherence, objectively measured, were more prominent in blacks. These racial differences were not explained by sociodemographic or clinical characteristics or clinical treatment variables. Premorbid intellect and the quality of support received contributed to clinical treatment and self-care.
  
  
  CONCLUSIONS
  Although few differences in clinical treatment could be attributed solely to race, knowledge about HF and medication adherence is lower in blacks than whites. Further research is needed to explain these observations, which may be targets for future intervention research.
authors: New York University College of Nursing, New York, NY (V.V.D.).
authors: Victoria Vaughan
authors: VV
authors: Dickson
authors: University of North Carolina School of Nursing, Chapel Hill, NC (G.J.K.).
authors: George J
authors: GJ
authors: Knafl
authors: Heart FailureTransplant Program, University of Pennsylvania, Philadelphia, PA (J.W.).
authors: Joyce
authors: J
authors: Wald
authors: University of Pennsylvania School of Nursing, Philadelphia, PA (B.R.).
authors: Barbara
authors: B
authors: Riegel
mesh_terms: D044383:Black People / Q000706:statistics & numerical data*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012648:Self Care / Q000706:statistics & numerical data*; D013318:Stroke Volume; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American; D016903:Drug Monitoring
chemical_list: D002316:Cardiotonic Agents
keywords: African Americans; comorbidity; ethnic groups; evidence‐based medicine; guideline adherence; medication adherence; self‐care