TY - JOUR
T1 - Predictors of mortality by sex and race in heart failure with preserved ejection fraction
T2 - Aric community surveillance study
AU - Sharma, Kavita
AU - Mok, Yejin
AU - Kwak, Lucia
AU - Agarwal, Sunil K.
AU - Chang, Patricia P.
AU - Deswal, Anita
AU - Shah, Amil M.
AU - Kitzman, Dalane W.
AU - Wruck, Lisa M.
AU - Loehr, Laura R.
AU - Heiss, Gerardo
AU - Coresh, Josef
AU - Rosamond, Wayne D.
AU - Solomon, Scott D.
AU - Matsushita, Kunihiro
AU - Russell, Stuart D.
N1 - Publisher Copyright:
© 2020 The Authors.
PY - 2020
Y1 - 2020
N2 - BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all-cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. METHODS AND RESULTS: Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1-year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [P=0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [P=0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. CONCLUSIONS: In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex-and race-based differences in predictors of mortality may help strategize targeted management of HFpEF.
AB - BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all-cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. METHODS AND RESULTS: Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1-year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [P=0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [P=0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. CONCLUSIONS: In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex-and race-based differences in predictors of mortality may help strategize targeted management of HFpEF.
KW - Epidemiology
KW - Heart failure with preserved ejection fraction
KW - Outcomes
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U2 - 10.1161/JAHA.119.014669
DO - 10.1161/JAHA.119.014669
M3 - Article
C2 - 32924735
AN - SCOPUS:85092682252
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 19
M1 - e014669
ER -