Ethnic disparity in the clinical characteristics of patients with heart failure

Abstract

Aims The characteristics of heart failure (HF) patients of different ethnic backgrounds in Israel are unknown. The purpose of the present study was to evaluate the clinical characteristics of Arab vs. Jewish patients with chronic HF. Methods and results Patients with a diagnosis of HF at a health maintenance organization in Jerusalem, Israel were evaluated. All patients were followed for cardiac‐related hospitalizations and death. The study cohort included 6773 HF patients; 4991 (74%) were Jewish and 1735 (26%) were Arab. The overall prevalence of HF in the Jewish vs. Arab population was similar (women, 4.3% vs. 4.7%, respectively, P = 0.06; men, 5.3% vs. 5.2%, P = 0.61). The prevalence of HF was significantly higher in Arab subjects of younger age groups (50–70 years). Arabs developed HF on average 10 years earlier and had a significantly higher rate of diabetes and obesity. Standard of care based on prescribed medications was similar between the ethnic groups. Glucose and cholesterol levels were higher in the Arab cohort. Mortality was similar between the groups at median follow‐up (576 days), with the exception of cardiovascular hospitalizations and death that were higher in Arab men. Conclusions Arab subjects develop HF at a much younger age compared with their Jewish counterparts and have a higher prevalence of diabetes and obesity. Standard of care and clinical outcome are comparable. Implementation of prevention programmes to reduce risk factors, particularly diabetes and obesity, may help reduce the disparity between Arabs and Jews.

August 2015 at a glance

“…The clinical characteristics, treatment and outcomes of patients with HF enrolled in a prospective, hospital‐based registry in Trivandrum, Kerala, India, are shown . Differences between Arab and Jewish patients with HF living in Jerusalem, Israel, are assessed by Gotsman et al and discussed by Hauptman …”

N‐terminal pro‐B‐type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure

“…Inter-ethnic differences in the incidence, symptoms, underlying pathophysiology, and treatment of heart failure (HF) have been described. [1][2][3][4] However, most epidemiological studies and therapeutic trials have focused exclusively on Caucasian populations, and available data on HF in Asian populations are scarce. 5 Previously, Asian HF patients have been reported to have lower mortality rates than did their Caucasian peers.…”

Addressing disparities in heart failure care without borders

“…It is in this context that Gotsman and colleagues examined risk factors, treatment, and outcomes in two populations in Jerusalem: Israeli Arabs and Jews. Taking advantage of a rich database from the Clalit Health Service, the largest health maintenance organization in Israel, they demonstrate similar prevalence of heart failure and use of standard of care medications in a cohort of nearly 7000 patients.…”

“…Age has also been studied . However, there are few, if any, studies that address differences by patient ethnicity, race or religion, which makes the paper by Gotsman and colleagues even more significant.…”

“…Objectively seeking an understanding of the influences on outcomes is an important task. As such, Gotsman and colleagues are to be congratulated for collecting and presenting their data. Now the ‘heavy lifting’ begins, expanding the research and devising well‐constructed interventions to modify risk factors and to improve outcomes for all Jerusalemites.…”