Racial differences in mortality in patients with advanced systolic heart failure: Potential role of right ventricular ejection fraction

Michel White*, Kanan Patel, Guillem Caldentey, Prakash Deedwania, Raya Kheirbek, Ross D. Fletcher, Inmaculada B. Aban, Alexander Lo, Wilbert S. Aronow, Gregg C. Fonarow, Stefan D. Anker, Ali Ahmed

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

In Beta-Blocker Evaluation of Survival Trial (BEST) bucindolol significantly reduced mortality among Caucasians with systolic heart failure (HF) but not among African Americans. Whether this differential effect can be explained by racial differences in baseline characteristics has not been previously examined. Of the 2708 BEST participants, 627 were African Americans. Because African Americans were more likely to be younger and women, we used age-sex-adjusted hazard ratios (HR) and 95% confidence intervals (CI) to estimate their outcomes (vs. Caucasians). A step-wise multivariable-adjusted model using 24 baseline characteristics was used to identify variables associated with between-race outcome differences and propensity-matching was used to determine independence of associations. Age-sex-adjusted HR for all-cause mortality for African Americans during 2 years of mean follow-up was 1.27. African Americans were more likely to have lower right ventricular ejection fraction. African Americans had no association with mortality among propensity-matched patients. The higher risk of death among African Americans in BEST may in part be due to their lower RVEF which may in part explain the lack of response to bucindolol among these patients. Future studies need to examine the role of low RVEF on the effect of beta-blockers in patients with systolic HF.

Original languageEnglish (US)
Pages (from-to)255-260
Number of pages6
JournalInternational Journal of Cardiology
Volume177
Issue number1
DOIs
StatePublished - Nov 15 2014

Keywords

  • Ejection fraction
  • Heart failure
  • Mortality
  • Race

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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