Clinical InvestigationCongestive Heart FailureAssociation of race/ethnicity with clinical risk factors, quality of care, and acute outcomes in patients hospitalized with heart failure
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,
References (23)
- et al.
Heart failure in Hispanics
J Am Coll Cardiol
(2009) Heart failure in African Americans: a cardiovascular enigma
J Card Fail
(2000)Heart failure in African Americans: pathophysiology and treatment
J Card Fail
(2003)- et al.
Quality of care of and outcomes for blacks hospitalized with heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry
J Am Coll Cardiol
(2008) - et al.
Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity
Am Heart J
(1999) - et al.
Clinical characteristics, process of care, and outcomes of Hispanic patients presenting with non–ST-segment elevation acute coronary syndromes: results from Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE)
Am Heart J
(2006) - et al.
Hospitalization for congestive heart failure. Explaining racial differences
JAMA
(1995) - et al.
Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis
Arch Intern Med
(2008) - et al.
Racial differences in incident heart failure among young adults
N Engl J Med
(2009) US Department of Commerce
Race, quality of care, and outcomes of elderly patients hospitalized with heart failure
JAMA
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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.