Ethnic Differences in 1-Year Mortality Among Patients Hospitalised With Heart Failure

Aug 11, 2011
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Authors:
Kaul P, McAlister FA, Ezekowitz JA, Grover VK, Quan H.
Citation:
Heart 2011;97:1048-1053.
Summary By:
Jennifer Ann Cowger, MD, MS, FACC

Study Questions:

Does ethnicity impact mortality on heart failure (HF)?

Methods:

All adult residents (n = 55,938) of Alberta, Canada hospitalized with an ICD-9 discharge diagnosis of HF comprised the cohort. Patients were categorized as white (n = 52,980), Chinese (n = 851), or East Indian (n = 377). The primary outcome of interest was 1-year mortality based on ethnicity.

Results:

The median [25th, 75th] age for whites, Chinese, and East Indian patients was 79 [70, 85], 80 [72, 86], and 74 [66, 80] years, respectively (p < 0.01). East Indians were more likely to have diabetes and ischemic heart disease, whereas Chinese patients had a greater prevalence of renal disease. Mortality during the index HF hospitalization was 14%, 21%, and 13% among white, Chinese, and East Indians, respectively (p < 0.01). One-year cumulative mortality was 31% among white patients, 39% among Chinese, and 27% among East Indians (p < 0.01 for Chinese vs. whites and Chinese vs. East Indians; p = 0.47 for East Indian vs. whites). After adjusting for differences in baseline characteristics, the hazard ratio [95% confidence interval] for 1-year mortality was 1.3 [1.2-1.5] for Chinese and 1.04 [0.85-1.3] for East Indians compared with whites. Excluding patients with renal disease, mortality was 35% in Chinese patients, 22% in East Indians, and 29% in whites (HR, 1.4 [1.2-1.6] for Chinese vs. white patients). Chinese and East Indian patients had more outpatient clinic visits than whites.

Conclusions:

The authors concluded that patient ethnicity may impact HF outcomes.

Perspective:

This population study demonstrates important differences in patient outcome based on ethnicity. East Indian patients had a high burden of high-risk comorbidities (diabetes, coronary disease), but mortality was equivalent to that of whites after adjusting for baseline characteristics. Why Chinese patients with HF in Alberta fared worse than whites and East Indians despite similar medication use and similar (compared with East Indians) or better (compared with whites) access to outpatient care is unclear.

Keywords: European Continental Ancestry Group, Canada, Heart Failure, Coronary Disease, Hospitalization, Diabetes Mellitus


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