Gurwitz Jerry H, Magid David J, Smith David H, Hsu Grace, Sung Sue Hee, Allen Larry A, McManus David D, Goldberg Robert J, Go Alan S
Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, and Reliant Medical Group, Worcester, Mass; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass; Department of Medicine, University of Massachusetts Medical School, Worcester, Mass.
Institute for Health Research, Kaiser Permanente Colorado, Denver.
Am J Med. 2015 Jun;128(6):591-600. doi: 10.1016/j.amjmed.2014.11.034. Epub 2014 Dec 30.
An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians) in adults with heart failure with preserved ejection fraction.
We identified all adults with heart failure with preserved ejection fraction between 2005 and 2008 from 4 health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses.
Among 13,437 adults with confirmed heart failure with preserved ejection fraction, 85.9% were white, 7.6% were black, and 6.5% were Asian. After adjustment for potential confounders and use of cardiovascular therapies, compared with whites, blacks (adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.62-0.85) and Asians (HR, 0.75; 95% CI, 0.64-0.87) had a lower risk of death from any cause. Compared with whites, blacks had a higher risk of hospitalization for heart failure (HR, 1.48; 95% CI, 1.29-1.68); no difference was observed for Asians compared with whites (HR, 1.01; 95% CI, 0.86-1.18). Compared with whites, no significant differences were detected in risk of hospitalization for any cause for blacks (HR, 1.03; 95% CI, 0.95-1.12) and Asians (HR, 0.93; 95% CI, 0.85-1.02).
In a diverse population with heart failure with preserved ejection fraction, we observed complex relationships between race and important clinical outcomes. More detailed studies of large populations are needed to fully characterize the epidemiologic picture and to elucidate potential pathophysiologic and treatment-response differences that may relate to race.
更好地理解心力衰竭自然史、临床特征及预后方面的种族差异，将具有重要的临床和公共卫生意义。我们评估了射血分数保留的心力衰竭成年患者中，不同种族群体（白人、黑人及亚洲人）的临床特征和预后如何变化。
我们利用医院主要出院诊断和门诊就诊诊断，从心血管研究网络的4个医疗系统中识别出2005年至2008年间所有射血分数保留的心力衰竭成年患者。
在13437例确诊为射血分数保留的心力衰竭成年患者中，85.9%为白人，7.6%为黑人，6.5%为亚洲人。在对潜在混杂因素和心血管治疗的使用进行调整后，与白人相比，黑人（调整后风险比[HR]，0.72；95%置信区间[CI]，0.62 - 0.85）和亚洲人（HR，0.75；95%CI，0.64 - 0.87）的任何原因死亡风险较低。与白人相比，黑人因心力衰竭住院的风险更高（HR，1.48；95%CI，1.29 - 1.68）；亚洲人与白人相比未观察到差异（HR，1.01；95%CI，0.86 - 1.18）。与白人相比，黑人（HR，1.03；95%CI，0.95 - 1.12）和亚洲人（HR，0.93；95%CI，0.85 - 1.02）因任何原因住院的风险均未检测到显著差异。
在射血分数保留的心力衰竭的多样化人群中，我们观察到种族与重要临床预后之间存在复杂关系。需要对大量人群进行更详细的研究，以充分描述流行病学情况，并阐明可能与种族相关的潜在病理生理和治疗反应差异。
