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Racial Differences and Prognosis with LV Dysfunction

Mortality rates from congestive heart failure have been reported by some studies to be higher among blacks than whites. Investigators retrospectively analyzed data from the Studies of Left Ventricular Dysfunction (SOLVD) prevention and treatment trials to compare mortality rates of black and white subjects. Black trial participants were younger than white participants but had similar functional status and left ventricular (LV) ejection fraction. Mean follow-up was 32 to 34 months.

In multivariate analyses adjusted for age; sex; coexisting conditions; severity and etiology of heart failure; and medication use, blacks had higher mortality rates than did whites. In both the prevention (asymptomatic LV systolic dysfunction) and treatment (symptomatic LV systolic dysfunction) trials, blacks had a higher risk for death from all causes (RR, 1.36; 95 percent CI, 1.06-1.74 and RR, 1.25; 95 percent CI, 1.04-1.50, respectively), death from pump failure (RR, 1.57; 95 percent CI, 1.01-2.44 and RR, 1.32; 95 percent CI, 1.02-1.70, respectively), and death from any cause or hospitalization for heart failure (RR, 1.54; 95 percent CI, 1.27-1.88 and RR, 1.28; 95 percent CI, 1.10-1.49, respectively). This higher risk for blacks persisted after adjustment for socioeconomic differences.

Comment: These results confirmed that blacks have higher mortality rates with LV dysfunction but failed to explain the finding. The data suggest that differences in the quality of treatment and follow-up do not explain the racial differences in outcomes.

— HM Krumholz

Published in Journal Watch Cardiology April 9, 1999

Citation(s):

Dries DL et al. Racial differences in the outcome of left ventricular dysfunction. N Engl J Med 1999 Feb 25 340 609-616.

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