Race Alone Not a Factor in Heart Failure

Race by itself is not a factor in heart failure when white and non-white patients are evenly matched on baseline variables such as age, weight, medical history and cardiac function, according to new research from UAB (University of Alabama at Birmingham). The findings, published in the June issue of the Journal of Cardiac Failure, are the first to use a propensity-matched technique to look at racial disparities in heart failure.

July 8, 2008

• Race not a factor in heart failure

• Hypertension, diabetes must be controlled

BIRMINGHAM, Ala. - Race by itself is not a factor in heart failure when white and non-white patients are evenly matched on baseline variables such as age, weight, medical history and cardiac function, according to new research from UAB (University of Alabama at Birmingham). The findings, published in the June issue of the Journal of Cardiac Failure, are the first to use a propensity-matched technique to look at racial disparities in heart failure.

"Our findings show that when white and non-white patients are well matched for baseline covariates, there are no racial differences in major natural history end points," said Ali Ahmed, M.D., MPH, associate professor in the division of gerontology, geriatrics and palliative care medicine and director of UAB's Geriatric Heart Failure Clinic and the study's lead investigator. "While it is reported that heart failure may be worse in non-whites, particularly African Americans, our findings suggest we have to look beyond race to discover the causes."

Ahmed's group studied 7,788 patients enrolled in the Digitalis Investigation Group, a large clinic trial of heart failure patients conducted in 302 centers in the United States and Canada from 1991-1993.  The study was funded by a grant from the National Heart, Lung and Blood Institute (NHLBI), one of the National Institutes of Health.

"We did find that before matching there were significant racial differences in baseline characteristics between white and nonwhite patients, differences that disappear following matching," said Ahmed. "This indicates race may be a marker for other variables that may play a role in the onset and progression of heart failure."           

Ahmed and colleagues did find a trend for increased risk of hospitalization for worsening heart failure among nonwhites compared to whites.

"The higher prevalence of hypertension, diabetes and cardiomegaly, and the development of heart failure at a younger age among nonwhites, highlight the need for early detection and optimal treatment of hypertension and diabetes and primary prevention of heart failure at an earlier age in these patients." said Ahmed.

Hospitalization due to heart failure is the leading cause of hospitalization among older adults, and with the aging of the baby boomers, the number of heart failure patients and heart failure hospitalizations are projected to double over the next couple of decades.

Dr. Ahmed's co-researchers were Giovanni Gambassi, M.D., Universita Cattolica del Sacro Cuore, Rome, Italy; Syed Abbas Agha, M.D., Grigorios Giamouzis, M.D., Ph.D., and Javed Butler, M.D., MPH, Emory University, Atlanta; Xuemei Sui, M.D., MPH, University of South Carolina, Columbia; Clyde W. Yancy, M.D., Baylor University Medical Center, Dallas; and Tom Love, Ph.D., Case Western Reserve University, Cleveland.

NOTE: The University of Alabama at Birmingham is a separate, independent institution from the University of Alabama, which is located in Tuscaloosa. Please use University of Alabama at Birmingham on first reference and UAB on second reference.