Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, New York, NY.
J Am Heart Assoc. 2017 Mar 29;6(4):e003330. doi: 10.1161/JAHA.116.003330.
Sex and race have emerged as important contributors to the phenotypic heterogeneity of heart failure with preserved ejection fraction (HFpEF). However, there remains a need to identify important sex- and race-related differences in characteristics and outcomes using a nationally representative cohort.
Data were obtained from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project-Nationwide Inpatient Sample files between 2008 and 2012. Hospitalizations with a diagnosis of HFpEF were included for analysis. Demographics, hospital characteristics, and age-adjusted comorbidity prevalence rates were compared between men and women and whites and blacks. In-hospital mortality was determined and compared for each subgroup. Multivariable regression analyses were used to identify and compare correlates of in-hospital mortality for each subgroup. A sample of 1 889 608 hospitalizations was analyzed. Men with HFpEF were slightly younger than women with HFpEF and had a higher Elixhauser comorbidity score. Men experienced higher in-hospital mortality compared with women, a finding that was attenuated after adjusting for comorbidity. Blacks with HFpEF were younger than whites with HFpEF, with lower rates of most comorbidities. Hypertension, diabetes, anemia, and chronic renal failure were more common among blacks. Blacks experienced lower in-hospital mortality compared with whites, even after adjusting for age and comorbidity. Important correlates of mortality among all 4 subgroups included pulmonary circulation disorders, liver disease, and chronic renal failure. Atrial fibrillation was an important correlate of mortality only among women and blacks.
Differences in patient characteristics and outcomes reinforce the notion that sex and race contribute to the phenotypic heterogeneity of HFpEF.
性别和种族已成为射血分数保留型心力衰竭（HFpEF）表型异质性的重要影响因素。然而，仍需要使用具有代表性的全国性队列来确定与性别和种族相关的重要特征和结局差异。
数据来自 2008 年至 2012 年期间美国医疗保健研究与质量医疗保健成本和利用项目国家住院患者样本文件。纳入 HFpEF 诊断的住院患者进行分析。比较了男性和女性以及白人和黑人之间的人口统计学、医院特征和年龄调整后共病患病率。确定了住院期间的死亡率，并对每个亚组进行了比较。使用多变量回归分析确定并比较了每个亚组住院期间死亡率的相关因素。对 1889608 例住院患者进行了分析。HFpEF 男性比女性稍年轻，Elixhauser 共病评分更高。与女性相比，男性的住院期间死亡率更高，但在调整共病后这一发现有所减弱。HFpEF 的黑人比白人年轻，大多数共病的发病率较低。黑人高血压、糖尿病、贫血和慢性肾衰竭的发病率较高。即使在调整年龄和共病后，黑人的住院期间死亡率仍低于白人。所有 4 个亚组中死亡率的重要相关因素包括肺循环疾病、肝脏疾病和慢性肾衰竭。心房颤动是女性和黑人死亡率的重要相关因素。
患者特征和结局的差异强化了性别和种族对 HFpEF 表型异质性的影响。
