Better short-term survival of blacks with heart failure is linked to less severe illness at hospital admission
Research Activities, July 2009, No. 347
Blacks suffer from higher rates of heart failure as well as related hospitalizations and deaths than whites. Yet, paradoxically, black patients hospitalized for heart failure have better short-term survival than white patients. One reason may be that black patients are less severely ill when they arrive at the emergency department (ED), suggests a new study. The University of Pittsburgh researchers analyzed 1,408 black and 7,260 white patients in one State, who were admitted to the hospital from the ED during 2003 and 2004 and discharged with a diagnosis of heart failure. The researchers used three clinical prediction rules to estimate patients' severity of illness at the time of hospital admission.
Overall, black patients were younger than white patients (65.8 vs. 77.4 years) and were 1.16 to 4.3 times more likely to be assigned to the lowest risk classes by the three prediction rules. The authors suggest several possible explanations for this. Blacks are less likely than whites to have a usual source of care and thus may be more likely to seek initial treatment for heart failure in the ED. Better access to primary care for white patients may paradoxically result in greater severity of illness when they do arrive at the ED, because they are more likely to visit the ED after failure of initial outpatient treatment.
After adjusting for hospital clustering, blacks were 25 percent less likely to suffer hospital death and complications and 66 percent less likely to die within 30 days. These findings suggest a varying opportunity between black and white patients when considering alternative initial treatment strategies and site of care, conclude the researchers. Their study was supported by the Agency for Healthcare Research and Quality (HS10888).
More details are in "Differences in initial severity of illness between black and white emergency department patients hospitalized with heart failure," by Thomas E. Auble, Ph.D., Margaret Hsieh, M.D., M.S., and Donald M. Yealy, M.D., in the February 2009 American Heart Journal 157(2), pp. 306-311.