Race/Ethnic Differences in HFpEF Patients

May 22, 2017
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Authors:
Ziaeian B, Heidenreich PA, Xu H, et al.
Citation:
Race/Ethnic Differences in Outcomes Among Hospitalized Medicare Patients With Heart Failure and Preserved Ejection Fraction. JACC Heart Fail 2017;May 10:[Epub ahead of print].
Summary By:
Monica M. Colvin, MD

Study Questions:

Are there ethnic differences in outcomes of older adults hospitalized with heart failure with preserved ejection fraction (HFpEF)?

Methods:

A cohort was identified from the Get With the Guidelines–Heart Failure registry. Patients had to be Medicare-eligible and discharged after admission for HFpEF. Primary outcomes included 30-day and 1-year mortality and readmission rates.

Results:

The final cohort included 53,065 patients. The average age of hospitalization was 83 years for white, 77 years for black, 79 years for Hispanic, and 81 years for Asian patients. There was a higher prevalence of women among black patients. Blacks and Hispanics had higher rates of diabetes, hypertension, and median body mass index compared with other groups, and lower rates of atrial fibrillation. Chronic kidney disease and dialysis were higher among blacks, Hispanics, and Asians compared with whites. Overall 30-day mortality was 5.87% and 1-year mortality was 33.10%. Mortality was lower in ethnic minorities compared with whites, whereas readmission rates were higher among blacks and Hispanics. Overall readmission rates were 22.16% and 66.95% at 30 days and 1 year, respectively. After adjustment for patient, hospital, and socioeconomic status (SES) factors, black and Hispanic ethnicities were associated with lower 30-day mortality compared with whites, and black, Hispanic, and Asian ethnicities had lower 1-year mortality. All-cause 30-day and 1-year readmissions were higher among blacks when compared with whites after adjustment for patient, hospital, and SES factors. Hispanics had a significantly higher rate of cardiovascular and HF-related readmissions after adjustment.

Conclusions:

Black and Hispanic patients with HFpEF have lower short-term and long-term mortality compared with whites, but higher readmission rates. Furthermore, ethnic minorities have a higher burden of comorbid conditions that may complicate HFpEF.

Perspective:

HFpEF accounts for an increasing proportion of hospitalizations and readmissions for HF, and ethnic variations in outcome exist. More study is needed to improve outcomes for all patients and to specifically address readmissions and comorbid conditions.

Keywords: African Americans, Asian Americans, Atrial Fibrillation, Body Mass Index, Diabetes Mellitus, Heart Failure, Heart Failure, Diastolic, Hispanic Americans, Hypertension, Medicare, Geriatrics, Patient Readmission, Renal Dialysis, Renal Insufficiency, Chronic, Social Class, Stroke Volume


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