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In-hospital survival higher for Hispanics with HF, preserved ejection fraction
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Among HF patients with preserved ejection fraction, Hispanics are more likely than non-Hispanic whites to survive their hospital stays, according to an analysis of data from the American Heart Association’s Get With The Guidelines–Heart Failure program.
Researchers analyzed data from 247 US hospitals in the Get With The Guidelines–Heart Failure quality improvement program in 2005 to 2010. More than 77,000 patients who experienced an episode of new or worsening HF as the primary reason for hospital admission or with significant HF symptoms that developed during hospitalization for which HF was the primary discharge diagnosis were included in the analysis.
Forty-six percent of Hispanic patients had preserved ejection fraction (>40%) compared with 55% of non-Hispanic white patients.
Multivariate analysis showed that Hispanic patients with preserved ejection fraction had a lower mortality risk (OR=0.55; 95% CI, 0.37-0.81). However, the lower mortality risk was not observed in Hispanics with reduced ejection fraction (OR=0.91; 95% CI, 0.66-1.28).
Among patients with preserved ejection fraction, Hispanic patients were 50% less likely than non-Hispanic whites to die during their hospital stays (1.4% vs. 2.9%; P<.0001). There were no differences in hospital survival between Hispanic and non-Hispanic white HF patients with reduced ejection fraction (2.6% vs. 3.3%, respectively; P=.0231). The survival difference was concentrated in the 65 years to 85 years age group, the researchers said.
Researchers found no major differences in quality of care among Hispanic and non-Hispanic white patients, regardless of heart function.
Adherence to ACE inhibitors or angiotensin receptor blocker use, beta-blocker use and receipt of discharge instructions was greater in Hispanic patients with preserved ejection fraction. Study results also showed that more Hispanic patients were discharged home while fewer were discharged to a skilled nursing facility vs. white patients in both preserved and reduced ejection fraction groups. Compared with non-Hispanic whites, Hispanics with preserved ejection fraction were more likely to be younger and to have diabetes, hypertension and be overweight or obese.
“The study suggests that participation in quality of care initiatives, such as Get With The Guidelines, is a positive step toward reduction in health care disparities, in terms of delivering quality of care to all HF patients,” Rey P. Vivo, MD, a fellow in the division of cardiology at the University of Texas Medical Branch in Galveston and the Methodist DeBakey Heart and Vascular Center, said in a press release. “In future studies, researchers should focus on what happens to HF patients from diverse ethnic groups after they leave the hospital, such as looking at readmission rate for 6 months or 1 year.”
Disclosure: Dr. Vivo reports no relevant financial disclosures. Several of the other researchers report a financial interest in Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Johnson & Johnson, Lilly, Medtronic, Merck, Novartis, Sanofi-Aventis, Schering-Plough and The Medicines Company.
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