Race/Ethnic Differences in Outcomes Among Hospitalized Medicare Patients With Heart Failure and Preserved Ejection Fraction

Ziaeian, Boback; Heidenreich, Paul A.; Xu, Haolin; DeVore, Adam D.; Matsouaka, Roland; Hernandez, Adrian F.; Bhatt, Deepak L.; Yancy, Clyde W.; Fonarow, Gregg C.

doi:10.1016/j.jchf.2017.02.012

Cited by 44 publications

(38 citation statements)

References 26 publications

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“…56 In patients with HFpEF, specifically, black patients were found to have higher readmission rates compared with white patients, and no difference was found in readmission rates for Hispanic and Asian patients compared with white patients. 57 The cohort size for Hispanic and Asian patients in these studies is much smaller and may have limited the statistical power to detect a difference in readmission rates. Several studies have reported that black and Hispanic patients hospitalized for HF tend to have lower 30-day and 1-year mortality rates, 56,58 and the etiology of these differences remains unclear.…”

Section: Demographic Characteristicsmentioning

confidence: 98%

Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature

Al’Aref

Beecy

et al. 2019

Mayo Clinic Proceedings

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Heart failure represents a clinical syndrome that results from a constellation of disease processes affecting myocardial function. Although recent studies have suggested a declining or stable incidence of heart failure, patients with heart failure continue to have high hospitalization and readmission rates, resulting in a substantial economic and public health burden. We searched PubMed and Google Scholar to identify published literature from 1998 through 2018 using the following keywords: heart failure, readmissions, predictors, prediction models, and interventions. Cited references were also used to identify relevant literature. Developments in the diagnosis and management of patients with heart failure have improved hospitalization and readmission rates in the past few decades. However, heart failure remains the most common cause of hospitalization in persons older than 65 years. As a result, given the enormous clinical and financial burden associated with heart failure readmissions on health care, there has been growing interest in the investigation of mechanisms aimed at improving outcomes and curtailing associated costs of care. Herein, we review the current literature on clinical and socioeconomic predictors of heart failure readmissions, briefly discussing limitations of existing strategies and providing an overview of current technology aimed at reducing hospitalizations.

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Section: Demographic Characteristicsmentioning

confidence: 98%

Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature

Al’Aref

Beecy

et al. 2019

Mayo Clinic Proceedings

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“…Studies have shown that ethnicity plays a role in disease progression and severity [24][25][26]. A large cohort study investigating 53,065 heart failure patients showed that one-year mortality was lower in Black, Hispanic and Asian patients compared to White patients [27] and a meta-analysis has shown that Indian and Malay ethnic groups in South East Asian countries are at higher risk to develop metabolic diseases like diabetes [28][29][30]. A propensity-matched study For every 1g/dL drop in haemoglobin done amongst coronary artery bypass graft patients showed that South Asian ethnicity had a survival benefit compared its predominantly White counterparts [31].…”

Section: Ethnicitymentioning

confidence: 99%

Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study

et al. 2020

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Background: While short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery. Methods: A retrospective cohort study of 2163 patients aged above 45 undergoing non-cardiac surgery in a university-affiliated tertiary hospital from January to July 2015 was performed. Relevant demographic, clinical and surgical data were analysed to elicit their relationship to mortality at one year after surgery. A univariate analysis was first performed to identify significant variables with p-values ≤ 0.2, which were then analysed using Firth multiple logistic regression to calculate the adjusted odds ratio. Results: The one-year mortality in our surgical population was 5.9%. The significant factors that increased one-year mortality include smoking (adjusted OR 2.17 (1.02-4.45), p = 0.044), anaemia (adjusted OR 1.32 (1.16-1.47), p < 0.001, for every 1 g/dL drop in haemoglobin level), lower BMI (adjusted OR 0.93 (0.87-0.98), p = 0.005, for every 1 point increase in BMI), Malay and Indian ethnicity (adjusted OR 2.68 (1.53-4.65), p = 0.001), peripheral vascular disease (adjusted OR 4.21 (1.62-10.38), p = 0.004), advanced age (adjusted OR 1.04 (1.01-1.06), p = 0.004, for every one year increase in age), emergency surgery (adjusted OR 2.26 (1.29-3.15), p = 0.005) and malignancy (adjusted OR 3.20 (1.85-5.52), p < 0.001). Conclusions: Our study shows that modifiable risk factors such as malnutrition, anaemia and smoking which affect short term mortality extend beyond the immediate perioperative period into longer term outcomes. Identification and optimization of this subset of patients are therefore vital. Further similar large studies should be done to develop a risk scoring system for post-operative long-term outcomes. This would aid clinicians in risk stratification, counselling and surgical planning, which will help in patients' decision making and care planning.

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“…9 Our finding of lower readmission risk for black patients is in contrast to findings from the general population, in which black, compared with white, race has been associated with increased risk of readmission both generally 10 and following a heart failure hospitalization. 13,14 Reasons for this are uncertain but may relate to the controversially termed phenomenon known as reverse epidemiology, 15 in which nonwhite adult patients receiving dialysis have generally more favorable outcomes than white adult patients. Further examination should be undertaken and findings leveraged to improve the care of patients of all races.…”

Section: Discussionmentioning

confidence: 99%

Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study

Wetmore

Molony

Liu

et al. 2018

JAHA

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BackgroundHospitalization for cardiovascular disease (CVD) is common among patients receiving maintenance dialysis, but patterns of readmissions following cardiovascular events are underexplored.Methods and ResultsIn this retrospective analysis of prevalent, Medicare‐eligible patients receiving dialysis in 2012–2013, all live‐discharge hospitalizations attributed to CVD were ascertained. Rates of all‐cause, CVD‐related, and non–CVD‐related readmissions and death in the ensuing 10 and 30 days were calculated. Multinomial logistic modeling was used to assess the relationship between potential explanatory factors and outcomes of interest. Among 142 210 analyzed hospitalizations, mean age at time of index CVD hospitalization was 64.9±14.1 years; 50.4% of index hospitalizations were for women, and 41.4% were for white patients. Fully 15.6% and 34.2% of CVD hospitalizations resulted in readmission within 10 and 30 days, respectively; less than half of readmissions were CVD related (42.5%, 10 days; 43.1%, 30 days). Death within 30 days, regardless of readmission, occurred after 4.5% of index hospitalizations; 51.2% were attributed to CVD. Compared with ages 65 to 69 years, younger age tended to be associated with increased readmission risk (adjusted relative risk for ages 18–44 years: 1.55; 95% confidence interval, 1.48–1.63). Readmission risk did not differ between white and black patients, but risk of death without readmission was markedly lower for black patients (relative risk: 0.60; 95% confidence interval, 0.55–0.67).ConclusionsRoughly 1 in 3 CVD hospitalizations resulted in 30‐day readmission; nearly 1 in 20 was followed by death within 30 days. Risk of death without readmission was higher for white than black patients, despite no difference in risk of readmission.

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Race/Ethnic Differences in Outcomes Among Hospitalized Medicare Patients With Heart Failure and Preserved Ejection Fraction

Cited by 44 publications

References 26 publications

Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature

Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature

Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study

Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study

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