Abstract 15841: African American Race is Independently Associated With Poorer Outcomes in Patients With Heart Failure Even in the Presence of Multiple Risk Factors for Poor Outcomes
Background: Health care disparities associated with race may influence event-free survival of heart failure (HF). There are known traditional risk factors that may partially explain these differences (e.g., functional status), but it is unknown whether other risk factors, such as depression, explain the poorer prognosis in African Americans.
Purpose: To determine whether racial disparities contribute to shorter event-free survival among patients with HF controlling for a number of covariates (i.e., medications, gender, age, education, marital status, NYHA functional class, ejection fraction, etiology, smoking, and depressive symptoms) that could potentially account for disparities.
Methods: We analyzed data from 993 outpatients enrolled in a multicenter HF registry who were followed for a median of 1.9 years (37% female, 11.3% African American, 64±13 yrs, 44% NYHA Class III/IV). Demographics, NYHA functional class, medications, and cardiac event data were collected via chart review and interview. Depressive symptoms were measured with the Patient Health Questionaire-9. Cox regression was used to determine whether African American race was associated with shorter event-free survival after controlling for all covariates.
Results: The multivariable-adjusted hazard ratios (95% confidence intervals) of older age 1.02 (1.00, 1.03), African American race 1.54 (1.09, 2.18), NYHA functional class 2.02 (1.64, 2.49), ischemic etiology 1.30 (1.04, 1.62), and depressive symptoms 1.04 (1.02, 1.06) were predictors of shorter cardiac event-free survival (all p<.05). African Americans were 1.54 times more likely to experience a cardiac event even after controlling for all other variables (p=.003).
Conclusion: African Americans with HF experienced a disparate risk of cardiac events not explained by a variety of clinical, demographic or psychological risk factors. Future research is needed to better understand health care disparities unique to African American patients and why they have worse HF outcomes.
- © 2013 by American Heart Association, Inc.