Ethnic differences in 1-year mortality among patients hospitalised with heart failure

Background: South Asians represent about 3% of the Canadian population and have a higher burden of certain cardiovascular risk factors and cardiovascular disease (CVD) compared with white people. The objective of this study was to review the literature to compare cardiovascular risk factors and disease management practices among adult South Asian and white Canadians. Methods:We searched MEDLINE, Embase, Cochrane and Cumulative Index to Nursing and Allied Health Literature databases from their inception through Feb. 17, 2014 and the reference lists of the selected articles. English-language studies of interventions and observational studies of biological mechanisms underlying CVD risk in South Asians conducted in Canada were eligible for inclusion. Where appropriate, we used random-effects meta-analyses to integrate results comparing the CVD risk profiles of South Asian and white Canadians. Results:We included 50 articles (n = 5 805 313 individuals) in this review. Compared with white Canadians, South Asian Canadians had a higher prevalence and incidence of CVD, an increased prevalence of diabetes (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.81 to 2.80, p < 0.001) and hypertension (OR 1.11, 95% CI 1.02 to 1.22, p = 0.02), lower high-density lipoprotein cholesterol levels (mean difference -0.19 mmol/L, 95% CI -0.25 to -0.13 mmol/L, p < 0.001) and a higher percentage of body fat (men: absolute mean difference 3.23%, 95% CI 0.83% to 5.62%, p = 0.008; women: absolute mean difference 4.09%, 95% CI 3.46% to 4.72%, p < 0.001). South Asian people are also more sedentary, consume higher levels of carbohydrates and are less likely to smoke tobacco (OR 0.38, 95% CI 0.24 to 0.60, p < 0.001]) than white Canadians. No differences in access to diagnostic tests, outcomes following cardiovascular surgery or use of cardiac rehabilitation programs were apparent.Interpretation: Compared with white people, South Asian people living in Canada have a higher prevalence and incidence of CVD and possess a unique cardiovascular risk profile. Abstract E184CMAJ OPEN, 2(3) Research CMAJ OPEN Methods Search strategy and selectionIn consultation with an information specialist, we developed search terms for MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Registry databases to identify human studies reporting associations among South Asian ethnicity, CVD risk factors and CVD. The initial search (conducted May 21, 2013) captured articles from database inception through May 2013; at the request of the CMAJ Open editors, the search was updated through to Feb. 17, 2014 (Appendix 1, available online at www.cmajopen.ca/content/2/3/E183/suppl/DC1). Three investigators (A.R., R.dS. and S.S.A.) each screened a third of the titles and abstracts of the studies identified in the electronic search to arrive at a list of articles for full-text review. The same 3 reviewers assessed the eligibility of these fulltext articles. Disagreements were resolved by discussion and consensus. Studies that were not p...

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“…were more likely to have hypertension compared with white people 3,4,9,14,27,28,31,32,[34][35][36]41,44 (OR 1.11, 95% CI 1.02 to 1.22, p = 0.02).…”

Section: Cmaj Openmentioning

confidence: 99%

Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis

et al. 2014

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“…Hispanic populations were similar to the White population while Asians, men in particular, had lower hospitalisation and mortality rates (the nature of the Asian population was not clarified but East Asians—Chinese and Japanese—are likely to be predominant). Kaul et al found, compared with White populations, comparatively high 1 year mortality in Chinese populations in Canada, but not Indians 9. CVD rates in Chinese populations are highly variable geographically 10.…”

Section: Introductionmentioning

confidence: 97%

Ethnic variations in heart failure: Scottish Health and Ethnicity Linkage Study (SHELS): Table 1

Bhopal¹,

Bansal²,

Fischbacher³

et al. 2012

Heart

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“…A recent study did highlight ethnic differences in mortality23 but our cohort was almost exclusively Caucasian and we are therefore unable to comment on any interaction between ethnicity and these prognostic tools. Despite this limitation, the cohort was selected on the basis of advanced NYHA class, representing the most severe symptoms and with the highest overall risk of death.…”

Section: Discussionmentioning

confidence: 89%

Identifying community based chronic heart failure patients in the last year of life: a comparison of the Gold Standards Framework Prognostic Indicator Guide and the Seattle Heart Failure Model

Haga

Murray

Reid

et al. 2012

Heart

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Ethnic differences in 1-year mortality among patients hospitalised with heart failure

Abstract: Ethnicity appears to modulate patient outcomes in heart failure. Chinese patients have significantly higher 1-year mortality rates compared with white patients; there appear to be no differences in mortality among East Indian and white patients.

Cited by 26 publications

References 36 publications

Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis

Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis

Ethnic variations in heart failure: Scottish Health and Ethnicity Linkage Study (SHELS): Table 1

Identifying community based chronic heart failure patients in the last year of life: a comparison of the Gold Standards Framework Prognostic Indicator Guide and the Seattle Heart Failure Model

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