Are There Race, Ethnic Differences in HFpEF Patients?

Black and Hispanic patients with heart failure with preserved ejection fraction (HFpEF) had lower rates of short- and long-term mortality but higher rates of hospital readmissions, compared with white patients, according to a study published June 26 in JACC: Heart Failure.

Researchers looked at 53,065 Medicare-eligible patients identified from the Get With the Guidelines-Heart Failure (GWTG-HF) Registry. Patients had to be discharged after admission for HFpEF. The GWTG-HF Registry was then linked to Centers for Medicare and Medicaid Services’ administrative data providing use of services, expenditures, and 30-day and one-year mortality and readmission rates.

Overall, the average age of hospitalization was 83 years for white patients, 77 years for black patients, 79 years for Hispanic patients and 81 years for Asian patients. Additionally, black and Hispanic patients 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 black, Hispanic and Asian patients compared with white patients.

Data showed overall 30-day mortality was 5.87 percent and one-year mortality was 33.10 percent. Overall readmission rates were 22.16 percent and 66.95 percent at 30 days and one year, respectively. After adjustment for patient, hospital and socioeconomic status factors, black and Hispanic patients were associated with lower 30-day mortality compared with whites, and black, Hispanic, and Asian patients had lower one-year mortality. All-cause 30-day and one-year readmissions were higher among black patients when compared with white patients after adjustment for patient, hospital and socio-economic status factors. Of note, Hispanic patients had a significantly higher rate of cardiovascular and heart failure-related readmissions after adjustment.

Study authors recommend future studies “to improve survival for all patients with HFpEF and reduce the hospitalization burden.” They also suggest that “targeted interventions may be needed to improve transitions after hospitalization for minority patients at high risk for readmission.”

In an Journal Scan, Monica M. Colvin, MD, writes that “HFpEF accounts for an increasing proportion of hospitalizations and readmissions for heart failure, and ethnic variations in outcome exist. More study is needed to improve outcomes for all patients and to specifically address readmissions and comorbid conditions.”

On the health policy front, Jennifer E. Ho, MD, FACC, notes in an accompanying editorial comment that recent data show improvements in 30-day risk-standardized readmission rates for heart failure following the passage of the Medicare Hospital Readmissions Reduction Program, particularly among lower-performing hospitals often serving the greatest proportion of minority patients. “These data illustrate the tremendous impact that policies and clinical interventions may bear on health outcomes and potentially on disparities in [heart failure],” she writes. 

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: African Americans, Atrial Fibrillation, Body Mass Index, Centers for Medicare and Medicaid Services (U.S.), Diabetes Mellitus, European Continental Ancestry Group, Health Expenditures, Health Policy, Heart Failure, Hispanic Americans, Hypertension, Medicaid, Patient Readmission, Registries, Renal Dialysis, Renal Insufficiency, Chronic

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