Race and the Natural History of Chronic Heart Failure: A Propensity-Matched Study

Gambassi, Giovanni; Agha, Syed A.; Sui, Xuemei; Yancy, Clyde W.; Butler, Javed; Giamouzis, Grigorios; Love, Thomas E.; Ahmed, Ali

doi:10.1016/j.cardfail.2008.02.004

Cited by 10 publications

(6 citation statements)

References 38 publications

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“…For example, African American HF patients (vs. Caucasians) who have an early onset of HF, 22 are also known to have a lower mean age. 23, 24 In the age-adjusted model, this early-stage disease would be expected to explain in part the relative survival advantage of VA patients despite a higher symptom and comorbidity burden that has been shown to be associated with poor outcomes. 25–29 A late-stage HF may also help explain the lower HF death and HF hospitalization among VA hospitals patients as pump failure is generally less common until HF is more advanced.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Patients With Advanced Chronic Systolic Heart Failure Receiving Care at the Veterans Affairs Versus Other Hospitals

Jones

Sin

Hage

et al. 2015

Circ: Heart Failure

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Background Characteristics and outcomes of patients with heart failure and reduced ejection fraction (HFrEF) receiving care at Veterans Affairs (VA) vs. non-VA hospitals have not been previously reported. Methods and Results In the randomized controlled Beta-Blocker Evaluation of Survival Trial (BEST; 1995–1999), of the 2707 (bucindolol=1353; placebo=1354) patients with HFrEF (EF ≤35%), 918 received care at VA hospitals, of which 98% (n=898) were men. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were men. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary endpoint of 2-year all-cause mortality (35% VA vs. 32% non-VA; hazard ratio {HR}, 1.09; 95% confidence interval {CI}, 0.94–1.26), which remained unchanged after adjustment for age and race (HR, 1.00; 95% CI, 0.86–1.16) or multivariable-adjustment including cardiovascular morbidities (HR, 0.94; 95% CI, 0.80–1.10). There was no between-group differences in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular EF <20% and peripheral arterial disease were significant predictors of mortality for both groups. African America race, New York Heart Association class IV symptoms, atrial fibrillation and right ventricular EF <20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant. Conclusions Patients with HFrEF receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to those younger and healthier receiving care at non-VA hospitals.

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Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Patients With Advanced Chronic Systolic Heart Failure Receiving Care at the Veterans Affairs Versus Other Hospitals

Jones

Sin

Hage

et al. 2015

Circ: Heart Failure

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“…However, unlike our study, that study was restricted to patients with left ventricular ejection fraction <35%, only half of the patients were receiving ACE inhibitors, and there was no data on race. A propensity-matched study of the effect of race on outcomes in DIG trial did not find any significant association between race and stroke hospitalization [34]. However, that analysis was not based on the DIG stroke sub-study data and misclassification of stroke is possible as hospitalization was not centrally adjudicated.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of stroke in chronic heart failure patients with normal sinus rhythm: Findings from the DIG stroke sub-study

Mujib

Giamouzis

Agha

et al. 2010

International Journal of Cardiology

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Background-Little is known about the epidemiology of stroke in chronic systolic and diastolic heart failure (HF) patients in normal sinus rhythm (NSR) receiving angiotensin-converting enzyme (ACE) inhibitors. Because all HF patients in the Digitalis Investigation Group (DIG) trial (N=7788) were in NSR and nearly all were receiving ACE inhibitors, a survey-based stroke substudy was conducted but its findings have never been published.Methods-DIG investigators confirmed a total 222 cases of stroke of which 144 had neurological deficit ≥24 hours. We used logistic regression models to determine predictors of incident stroke among all 7788 patients and predictors of neurological deficit ≥24 hours and allcause mortality among 222 stroke patients.Results-Age ≥65 years (adjusted odds ratio {AOR}, 1.36; 95% confidence interval {CI}, 1.02-1.80; P=0.035), nonwhite race (AOR, 0.65; 95% CI, 0.42-0.99; P=0.047), hypertension (AOR, 1.46; 95% CI, 1.11-1.94; P=0.008), diabetes mellitus (AOR, 1.37; 95% CI, 1.03-1.82; P=0.030), and cardiomegaly (AOR, 1.39; 95% CI, 1.03-1.86; P=0.030) were independent predictors of stroke. However, among those with stroke, nonwhites had higher odds of neurological deficits ≥24 hours (AOR, 2.86; 95% CI, 1.01-8.07; P=0.047) and death (AOR, 3.28; 95% CI,; P=0.012).Conclusion-Older age, hypertension, diabetes and cardiomegaly were associated with increased incidence of stroke among HF patients with NSR receiving ACE inhibitors. The association of race and stroke, however, was complex. While nonwhite race was associated with decreased risk of stroke, among those with stroke, nonwhite race was associated with increased stroke severity and mortality.

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“…Propensity scores for incident coronary revascularization for each of the 2973 patients with IHD were estimated using a non-parsimonious, multivariate logistic regression model, adjusting for key baseline covariates presented in Table 1. The propensity scores were then used for matching, and the details of the matching protocol have been described elsewhere [11–14]. Absolute standardized differences were estimated to examine covariate balance and were presented as a Love plot, developed by Thomas E. Love [11–13, 15, 16].…”

Section: Methodsmentioning

confidence: 99%

Incident coronary revascularization and subsequent mortality in chronic heart failure: A propensity-matched study

Giamouzis

Agha

Ekundayo

et al. 2010

International Journal of Cardiology

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Introduction-Ischemic heart disease (IHD) is common in heart failure (HF), yet the association between incident coronary revascularization and mortality in these patients has not been examined in a propensity-matched study.Methods-In the Digitalis Investigation Group trial, 2853 patients without coronary revascularization and 120 patients with coronary revascularization during the first three years were alive at the end of three years. We used propensity scores to match 119 and 357 patients with and without coronary revascularization. Matched Cox regression models were used to estimate hazard ratio (HR) and 95% confidence interval (CI) for mortality during the fourth year of follow-up, for all patients and by the mean left ventricular ejection fraction (LVEF) of 35%.Results-Coronary revascularization was associated with higher mean LVEF (36 % versus 32 %; p<0.0001) and prevalence of angina pectoris (48% versus 32%; p<0.0001) but fewer prior myocardial infarction (80% versus 87%; p=0.023), all of which were balanced post-match. All-cause mortality occurred in 5.9% and 6.2% patients respectively with and without coronary revascularization (HR for coronary revascularization, 0.95; 95% CI, 0.39-2.32; p=0.910). HR for mortality associated with coronary revascularization for patients with LVEF ≤35% and >35% were respectively 1.34 (95% CI, p=0.578) and 0.61 (95% CI, p=0.532).Conclusion-Chronic HF patients with IHD receiving coronary revascularization were more likely to have angina and higher LVEF. However, in a balanced propensity-matched cohort, there was no association between coronary revascularization and mortality. The LVEF-associated variation in mortality needs to be prospectively studied.

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Race and the Natural History of Chronic Heart Failure: A Propensity-Matched Study

Cited by 10 publications

References 38 publications

Characteristics and Outcomes of Patients With Advanced Chronic Systolic Heart Failure Receiving Care at the Veterans Affairs Versus Other Hospitals

Characteristics and Outcomes of Patients With Advanced Chronic Systolic Heart Failure Receiving Care at the Veterans Affairs Versus Other Hospitals

Epidemiology of stroke in chronic heart failure patients with normal sinus rhythm: Findings from the DIG stroke sub-study

Incident coronary revascularization and subsequent mortality in chronic heart failure: A propensity-matched study

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