Clinical Investigation
Congestive Heart Failure
Association of race/ethnicity with clinical risk factors, quality of care, and acute outcomes in patients hospitalized with heart failure

https://doi.org/10.1016/j.ahj.2011.01.012Get rights and content

Background

Black and Hispanic populations are at increased risk for developing heart failure (HF) at a younger age and experience differential morbidity and possibly differential mortality compared with whites. Yet, there have been insufficient data characterizing the clinical presentation, quality of care, and outcomes of patients hospitalized with HF as a function of race/ethnicity.

Methods

We analyzed 78,801 patients from 257 hospitals voluntarily participating in the American Heart Association's Get With The Guidelines–HF Program from January 2005 thru December 2008. There were 56,266 (71.4%) white, 17,775 (22.6%) black, and 4,760 (6.0%) Hispanic patients. In patients hospitalized with HF, we sought to assess clinical characteristics, adherence to core and other guideline-based HF care measures, and in-hospital mortality as a function of race and ethnicity.

Results

Relative to white patients, Hispanic and black patients were significantly younger (median age 78.0, 63.0, 64.0 years, respectively), had lower left ventricular ejection fractions, and had more diabetes mellitus and hypertension. With few exceptions, the provision of guideline-based care was comparable for black, Hispanic, and white patients. Black and Hispanic patients had lower in-hospital mortality than white patients: black/white odds ratio 0.69, 95% CI 0.62-0.78, P < .001 and Hispanic/white odds ratio 0.81, 95% CI 0.67-0.98, P = .03.

Conclusions

Hispanic and black patients hospitalized with HF have more cardiovascular risk factors than white patients; however; they have similar or better in-hospital mortality rates. Within the context of a national HF quality improvement program, HF care was equitable and improved in all racial/ethnic groups over time.

Section snippets

Methods

The GWTG-HF is a registry and performance-improvement program for patients hospitalized with HF, and the details of the program have been described previously.14 This voluntary program of the American Heart Association (AHA) collects data on various patient characteristics using a Web-based information system. Hospitals participating in the registry submit clinical information regarding the medical history, laboratories, diagnostic testing, hospital care, and outcomes of patients hospitalized

Patient characteristics

Of 78,801 patients hospitalized with HF and included in this analysis, just under half (49.1%) were women; and the mean age was 72.0 ± 14.4 years. The racial composition of the patients was 71.4% (56,266) non-Hispanic white, 22.6% (17,775) non-Hispanic black, and 6% (4.760) Hispanic. There were significant and substantial differences in the baseline demographics and clinical characteristics by race/ethnicity (Table I). Compared with white patients, Hispanic and black patients were considerably

Discussion

This is among the largest studies to characterize the clinical presentation, delivery of HF care, and outcomes for patients hospitalized with HF in a diverse population inclusive of Hispanics. Our study had 4 main findings. First, Hispanic and black patients relative to white patients hospitalized with HF were much younger and had more potentially modifiable risk factors, including diabetes mellitus and hypertension. Second, quality of care was similar or higher in Hispanic and black patients

Conclusions

In this very large, diverse racial/ethnic cohort of patients hospitalized with HF at institutions from all regions of the country over a 3-year period, we found substantial differences in baseline characteristics among black, Hispanic, and white patients, particularly in age of presentation. The strikingly younger age and high prevalence of obesity, hypertension, and diabetes mellitus among Hispanic and black patients indicate that health improvement efforts should focus on early prevention of

Financial disclosures

Dr Thomas reports receiving research grants from Medtronic (significant) and the National Institutes of Health (significant); serving as a consultant for Boston Scientific (modest), Medtronic (modest), and St. Jude Medical (modest); and receiving honoraria from Sanofi-Aventis (significant).

Dr Hernandez reports receiving research grants from Johnson & Johnson (Scios, Inc), Medtronic, and Merck and receiving honoraria within the past 2 years from AstraZeneca, Geron, Medtronic, Novartis,

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  • Cited by (0)

    Edward P. Havranek, MD served as guest editor for this article.

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    for the Get With the Guidelines Steering Committee and Hospitals.

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