Meta-Analysis Shows Lower Mortality Rates for African American Compared with White Patients Hospitalized for Heart Failure
FINDINGS:
- Adjusted mortality rates after hospitalization for heart failure (HF) were 32% lower in short-term follow-up (0-30 days) and 16% lower in long-term follow-up (after 30 days) for African American compared with white patients.
- Unadjusted mean mortality rates after HF hospitalization for African American and white patients, respectively, were: 6% and 9% (in-hospital), 6% and 10% (30-day mortality), 10% and 15% (60-180 day mortality), 28% and 34% (one-year mortality), and 41% and 47% (mortality after one year).
IMPLICATIONS:
- Authors suggest that differences in mortality imply unmeasured differences by race in clinical severity of illness at hospital admission and may lead to biased hospital mortality profiles.
- Authors also note that explanations for the lower mortality rate among African American patients are poorly understood and may include racial differences in: hospital use, physicians' diagnoses and admitting practices, patients' access to healthcare services, and health-seeking behaviors.
BACKGROUND:
After hospitalization for heart failure (HF), numerous reports indicate that mortality is lower in African American compared to white patients, but these findings have not been reviewed and examined together. This study examined research reporting mortality by race after hospitalization for HF, and combined the results using meta-analyses. Investigators identified 27 articles that fit their criteria, which were published from 1985 to March 2009 and represented 29 patient cohorts; 17% of cohorts were VA healthcare users. Studies were limited to those examining patients hospitalized in the U.S. and Canada because definitions of race may differ elsewhere. The primary outcome was all-cause mortality, including in-hospital and at 30 days, 60-180 days, one year, and after one year for unadjusted data; and short-term (0-30 days) and long-term (after 30 days) for adjusted data.
LIMITATIONS:
- Results are dependent on how consistently the studies classified African American and white race. Misclassification of race could affect the magnitude of the mortality differences observed.
- Other ethnic and racial groups were not evaluated, thus these findings are not generalizable.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (ECV 02-254). Dr. Gordon, Mr. Nowlin, and Mr. Maynard are part of HSR&D's Center for Management of Complex Chronic Care in Hines, IL.
Gordon H, Nowlin P, Maynard D, Berbaum M, and Deswal A. Mortality after Hospitalization for Heart Failure in Blacks Compared with Whites. American Journal of Cardiology March 1, 2010;105(5):694-700.
