Ethnic differences in the prevalence and aetiology of left ventricular systolic dysfunction in the community: the Harrow heart failure watch

Abstract

Objective: To assess ethnic differences in the prevalence and aetiology of left ventricular systolic dysfunction (LVSD) in the community. Design: Community cohort study. All patients underwent echocardiography and those found to have LVSD underwent myocardial perfusion imaging with or without coronary angiography to diagnose underlying coronary artery disease (CAD). Setting: Seven representative general practices in Harrow, UK, a community hospital, and a local district general hospital. Patients: 1392 patients > 45 years old randomly selected from the computer records of seven general practices. Main outcome measures: The prevalence and aetiology of LVSD in the community, assessing differences between white and non-white populations, and the proportion of patients with LVSD with undiagnosed CAD. Results: 734 patients (53%) attended, 518 (71%) white and 216 (29%) non-white, the majority South Asian. Thirty nine patients (5.5%) had probable LVSD and 25 (3.5%) definite LVSD. No significant differences in prevalence were seen with ethnicity. CAD underlay most cases of LVSD. Non-white patients had a higher prevalence of CAD as the underlying aetiology of significant LVSD than white patients (100% v 56%, p = 0.04) and a trend towards less alcoholic cardiomyopathy. 8% of patients with LVSD had undiagnosed CAD. Conclusions: LVSD is common. White and non-white patients have a similar overall prevalence of LVSD. Non-white patients, the majority South Asians in this study, have a higher prevalence of CAD as the underlying cause for LVSD than white patients. CAD underlies most cases of LVSD in the community, although it may be undiagnosed unless formally assessed.

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

“…Even comparing results using the standardised rates found in other White British men (379.5) (predominantly English)—436.5 in Indian men, 592.0 in Pakistani men (table 1)—however, does not show the kind of variations seen in Leicestershire11 and Birmingham 7. Crucially, the cross sectional study by Galasko et al in Harrow, England, showed no substantial difference between South Asian and White populations 4. The 2011 results of the prevalence study in Birmingham also help interpret the conflicting findings 5.…”

“…Furthermore, it is not possible to identify the specific cause of heart failure from the data we have since ICD code I50 does not distinguish valvular, rheumatic, ischaemic or other causes. In the UK setting, valvular and rheumatic heart disease are uncommon causes of heart failure 4 5…”

“…Socioeconomic status is strongly related to IHD and hypertension, and also to infectious diseases, including those leading to rheumatic fever. In recent studies, IHD, and risk factors such as hypertension and diabetes, were commonly associated with heart failure in South Asian and African origin ethnic minority groups in the UK, while both valvular disease and atrial fibrillation were much rarer, even although a large proportion of the population studied were born abroad, and valvular disease might have been expected to be commoner than actually observed 4 5…”

Cardiovascular Disease in South Asian Migrants

“…35 A UK study of left ventricular systolic dysfunction, found that non-Europids, the majority of whom were SA, had similar rates of left ventricular systolic dysfunction as Europids. 48 In contrast, in a retrospective cohort study from the UK of 5789 patients newly admitted with HF (336 SA, mean age 70, 43% women; 5057 Europid, mean age …”

Epidemiology and Management of Acute Decompensating Heart Failure in the Asia-Pacific Region

“…Indians have a higher hospital admission rate for congestive heart failure compared with the Chinese population in Singapore 12 . In Britain, Galasko and colleagues 13 showed that South Asians had a higher prevalence of coronary artery disease (CAD) as the underlying cause of left ventricular systolic dysfunction than do white patients 13 . Included in the limited published data on the management of heart failure in India is the very important consideration of patient compliance following the prescription of appropriate treatment 14 .…”