Duke University, Durham, NC.
Am Heart J. 2013 Sep;166(3):488-95. doi: 10.1016/j.ahj.2013.06.002. Epub 2013 Jul 12.
The strength of race as an independent predictor of long-term outcomes in a contemporary chronic heart failure (HF) population and its association with exercise training response have not been well established. We aimed to investigate the association between race and outcomes and to explore interactions with exercise training in patients with ambulatory HF.
We performed an analysis of HF-ACTION, which randomized 2331 patients with HF having an ejection fraction ≤35% to usual care with or without exercise training. We examined characteristics and outcomes (mortality/hospitalization, mortality, and cardiovascular mortality/HF hospitalization) by race using adjusted Cox models and explored an interaction with exercise training.
There were 749 self-identified black patients (33%). Blacks were younger with significantly more hypertension and diabetes, less ischemic etiology, and lower socioeconomic status versus whites. Blacks had shorter 6-minute walk distance and lower peak VO2 at baseline. Over a median follow-up of 2.5 years, black race was associated with increased risk for all outcomes except mortality. After multivariable adjustment, black race was associated with increased mortality/hospitalization (hazard ratio [HR] 1.16, 95% CI 1.01-1.33) and cardiovascular mortality/HF hospitalization (HR 1.46, 95% CI 1.20-1.77). The hazard associated with black race was largely caused by increased HF hospitalization (HR 1.58, 95% CI 1.27-1.96), given similar cardiovascular mortality. There was no interaction between race and exercise training on outcomes (P > .5).
Black race in patients with chronic HF was associated with increased prevalence of modifiable risk factors, lower exercise performance, and increased HF hospitalization, but not increased mortality or a differential response to exercise training.
种族作为一个独立的预测因素，在当代慢性心力衰竭（HF）人群中的长期结局及其与运动训练反应的关系尚未得到很好的确定。我们旨在研究种族与结局之间的关系，并探讨其与有活动能力的 HF 患者运动训练之间的相互作用。
我们对 HF-ACTION 进行了分析，该分析将 2331 名射血分数≤35%的 HF 患者随机分为常规治疗加或不加运动训练。我们使用调整后的 Cox 模型按种族检查特征和结局（死亡率/住院率、死亡率和心血管死亡率/HF 住院率），并探索与运动训练的相互作用。
有 749 名自我认定为黑人的患者（33%）。黑人患者年龄较小，高血压和糖尿病的比例显著较高，缺血性病因较少，社会经济地位较低。黑人患者的 6 分钟步行距离较短，峰值 VO2 较低。在中位数为 2.5 年的随访期间，黑人种族与所有结局的风险增加有关，除了死亡率。经过多变量调整后，黑人种族与死亡率/住院率增加（风险比[HR]1.16，95%可信区间[CI]1.01-1.33）和心血管死亡率/HF 住院率增加（HR 1.46，95%CI 1.20-1.77）有关。黑人种族与 HF 住院率增加有关（HR 1.58，95%CI 1.27-1.96），主要是由于 HF 住院率增加，而心血管死亡率相似。种族与运动训练对结局的相互作用无统计学意义（P>.5）。
慢性 HF 患者的黑人种族与可改变的危险因素患病率增加、运动表现降低和 HF 住院率增加有关，但与死亡率增加或运动训练反应的差异无关。
