Abstract 110: Racial Differences in Heart Failure Outcomes

Abstract

Background: Little is known about whether racial differences exist in patient-centered outcomes after a heart failure hospitalization. We sought to determine if there are racial differences in health status, readmission and mortality after hospitalization for heart failure. Methods: We analyzed 1427 patients with heart failure (636 non-Hispanic blacks, 45%; 791 non-Hispanic whites, 55%) in data from a randomized controlled trial (Telemonitoring to Improve Heart Failure Outcomes, NIH Clinical Trials # NCT00303212 ). We examined racial differences in quality of life by using the overall summary score of Kansas City Cardiomyopathy Questionnaire (KCCQ at baseline, 3 and 6 months), rehospitalization and mortality rates (30-day and 180-day). Generalized linear mixed models and propensity score methods were used to adjust for clustering within sites and differences between races. Results: Compared with whites, black patients were more likely to be younger, less well insured, a current smoker, have hypertension, cognitive impairment, and reduced left ventricular ejection fraction (<40%), but less likely to have hypercholesterolemia, coronary disease and peripheral vascular disease. While black patients reported better quality of life at baseline (black vs. white difference in KCCQ summary score: 6.22, 95% confidence interval [CI]: 2.98-9.46, P<0.001), after adjusting for patient demographics, comorbidities, and clinical laboratory values, we detected no significant racial differences at 3 (black vs. white difference in KCCQ score: 2.28, 95% CI: -0.84-5.41, P=0.15) or 6 months (black vs. white difference in KCCQ score: 1.91, 95% CI: -1.31-5.13, P=0.24). We observed no significant racial differences in 30-day (white: 18.3%, black: 16.4%, P=0.33) or 180-day unadjusted all-cause rehospitalization rate (white: 50.4%, black: 47.8%, P=0.32) and no differences in 30-day unadjusted mortality rate (white: 2.3%, black: 1.3%, P=0.15). Significant racial differences did occur in180-day unadjusted mortality rate (white: 13.4%, black: 9.0%, P=0.01), which were no longer apparent after adjusting for site and using propensity score methods to adjust for patient demographics, payer, socioeconomic status, comorbidities, and clinical laboratory values (adjusted odds ratio: 0.85, 95% CI: 0.52-1.37, P=0.49). Likewise, fully adjusted 180-day all-cause rehospitalization rates were similar (AOR: 0.92, 95% CI: 0.70-1.21, P=0.53). Conclusion: Compared with whites, black heart failure patients enrolled in this trial had higher self-reported quality of life at baseline. However, there were no racial differences in quality of life at 3 and 6 months and both blacks and whites experienced notable improvement in quality of life in the follow-up period. After adjustment for clustering and patient factors, no significant racial differences in mortality or rehospitalization rates were observed.