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*224. Diastolic Heart Failure in the Elderly: Lack of differences in 18-month Mortality by Ethnicity and Gender

Said A Ibrahim, MD, MPH, Louis Stokes Dept VAMC & CWRU, Cleveland, OH; Christopher Burant, MS, Louis Stokes Dept VAMC & CWRU, Cleveland, OH; C Kent Kwoh, MD, University of Pittsburgh Medical Center, Pittsburgh, PA

Objectives: Heart failure in the elderly is increasing. Diastolic heart failure is the most common type of heart failure in the US. Because so much has been learned about systolic heart failure, treatments that impact prognosis are available. In comparison, little is understood regarding the prognosis of diastolic heart failure, and no effective treatment is available. Because prognosis in systolic heart failure has been reported to vary by race and ethnicity, little similar data are available for diastolic heart failure. In this study, we examined 18-month mortality from diastolic heart failure by ethnicity and gender in a sub-sample of elderly patients hospitalized for heart failure.

Methods: The original sample included 12,911 patients 65 years of age or older who were admitted with a principal diagnosis of heart failure to 30 hospitals in Northeast Ohio between July 1992 and December 1994. Information on demographics, echocardiagraphy, and comorbidities were acquired. Mortality data for all patients were obtained from Ohio MEDPRO files for Medicare beneficiaries. Diastolic heart failure was defined as "having a principal diagnosis of heart failure and a left ventricular ejection fraction (LVEF) >50% by echo." Logistic regression was used to compare 18-month mortality for patients with diastolic heart failure by ethnicity (African American [AA] vs white) and by gender, adjusting for demographic and clinical covariates.

Results: In the original cohort, 16% were AA and 41% male. 28% of the cohort had LVEF assessment by echo; of these 1058 had diastolic heart failure. For those with diastolic heart failure, AAs and whites were comparable with respect to history of angina, stroke, use of dialysis, alcohol use, and male gender. AAs were more likely to have hypertension (50% vs 36%; P= 0.001), diabetes (46% vs 29%; P=0.000), history of tobacco use (27% vs 18%; P=0.011), high serum creatinine (1.99 +/- 2 vs 1.50 +/- 1; P= 0.003), and were younger (76 +/- 7 vs 79 +/- 8; P= 0.000). Whites were more likely to have a history of ischemic heart disease (48% vs 32%; P= 0.000), metstatic cancer (3% vs 0%; p=0.034), DNR status on record (14% vs 7%; P=0.013), and atrial fibrillation (24% vs 14%; P= 0.002). The AA to white crude and adjusted 18-month mortality rates were 0.78(0.53-1.16) and 1.03(0.66-1.59), respectively. For male vs female, the above- mentioned comorbodities were comparable, except women were more likely to have DNR status (16% vs 7.3%; P= 0.000) and to be older (79.5 +/- 8 vs 77 +/- 7; p+ 0.000). Males were more likely to have a history of tobacco use (30% vs 14%; P= 0.000), alcohol use (36% vs 15%; P+0.000), and higher serum creatinine level (1.7 +/- 1.2 vs 1.4 +/- 1.1; P= 0.001). Male to female crude and adjusted 18-month mortality rates were 0.99(0.74-1.31) and 1.06(0.76-1.46), respectively.

Conclusions: In a sample of elderly patients admitted for heart failure, there were no differences in 18-month crude and adjusted mortality by ethnicity or by gender for those with diastolic heart failure. Major limitations include lack of information on disease-specific severity and relatively short duration of follow up.

Impact: Congestive heart failure is a leading cause of hospital admission and resource utilization for elderly patients in the VA system. Diastolic heart failure is the most common type of heart failure. Understanding demographic variations in prognosis is important as we attempt to develop specific treatments for diastolic heart failure.