Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study
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 HFpE...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.014669 |
| _version_ | 1811333999306473472 |
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| author | Kavita Sharma Yejin Mok Lucia Kwak Sunil K. Agarwal Patricia P. Chang Anita Deswal Amil M. Shah Dalane W. Kitzman Lisa M. Wruck Laura R. Loehr Gerardo Heiss Josef Coresh Wayne D. Rosamond Scott D. Solomon Kunihiro Matsushita Stuart D. Russell |
| author_facet | Kavita Sharma Yejin Mok Lucia Kwak Sunil K. Agarwal Patricia P. Chang Anita Deswal Amil M. Shah Dalane W. Kitzman Lisa M. Wruck Laura R. Loehr Gerardo Heiss Josef Coresh Wayne D. Rosamond Scott D. Solomon Kunihiro Matsushita Stuart D. Russell |
| author_sort | Kavita Sharma |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T17:01:16Z |
| format | Article |
| id | doaj.art-4f278856bbec43b39668bac6880398df |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:01:16Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4f278856bbec43b39668bac6880398df2022-12-22T02:38:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-10-0191910.1161/JAHA.119.014669Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance StudyKavita Sharma0Yejin Mok1Lucia Kwak2Sunil K. Agarwal3Patricia P. Chang4Anita Deswal5Amil M. Shah6Dalane W. Kitzman7Lisa M. Wruck8Laura R. Loehr9Gerardo Heiss10Josef Coresh11Wayne D. Rosamond12Scott D. Solomon13Kunihiro Matsushita14Stuart D. Russell15Division of Cardiology The Johns Hopkins Hospital Baltimore MDDepartment of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MDDepartment of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MDMount Sinai Health Systems New York NYDepartment of Medicine University of North Carolina Chapel Hill NCSection of Cardiology Michael E. DeBakey VA Medical Center Baylor College of Medicine Houston TXCardiovascular Division Brigham and Women’s Hospital Boston MACardiology and Geriatrics Sections Department of Internal Medicine Wake Forest School of Medicine Winston‐Salem NCDuke Clinical Research InstituteCenter for Predictive Medicine Durham NCDepartment of Epidemiology University of North Carolina Chapel Hill NCDepartment of Epidemiology University of North Carolina Chapel Hill NCDepartment of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MDDepartment of Epidemiology University of North Carolina Chapel Hill NCCardiovascular Division Brigham and Women’s Hospital Boston MADepartment of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MDDuke University School of Medicine Durham NCBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.119.014669epidemiologyheart failure with preserved ejection fractionoutcomes |
| spellingShingle | Kavita Sharma Yejin Mok Lucia Kwak Sunil K. Agarwal Patricia P. Chang Anita Deswal Amil M. Shah Dalane W. Kitzman Lisa M. Wruck Laura R. Loehr Gerardo Heiss Josef Coresh Wayne D. Rosamond Scott D. Solomon Kunihiro Matsushita Stuart D. Russell Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease epidemiology heart failure with preserved ejection fraction outcomes |
| title | Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study |
| title_full | Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study |
| title_fullStr | Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study |
| title_full_unstemmed | Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study |
| title_short | Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study |
| title_sort | predictors of mortality by sex and race in heart failure with preserved ejection fraction aric community surveillance study |
| topic | epidemiology heart failure with preserved ejection fraction outcomes |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.014669 |
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