Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans

Am Heart J. 2002 Jun;143(6):1058-67. doi: 10.1067/mhj.2002.122123.


Background: National statistics indicate that African Americans are disproportionately affected by mortality and hospitalizations resulting from heart failure when compared with other racial/ethnic groups. This might, in part, reflect a poorer course of heart failure among African Americans.

Methods: We conducted a prospective cohort study of 316 white and 82 African American consecutive patients aged > or =50 years with decompensated heart failure on hospital admission. The outcome of the study was death or decline in activities of daily living function at 6 months relative to baseline.

Results: African American patients were on average 8 years younger and had less favorable socioeconomic and access-to-care indicators. African Americans more often had a history of hypertension, renal insufficiency, and diabetes, but there were no differences in functional status, self-reported health status, signs of decompensation, or left ventricular ejection fraction. Quality-of-care indicators did not differ by race. Mortality rates at 6 months were similar in African Americans and whites (19.5% vs 17.2%, age adjusted), but African Americans had a greater functional decline (37.6% vs 24.7%). After adjusting for baseline characteristics, African Americans had an almost 50% higher risk of either death or decline in activities of daily living functioning (relative risk 1.45, 95% CI, 1.06-1.81). Adjustment for socioeconomic, access-to-care and quality-of-care indicators did not substantially change this estimate.

Conclusions: African Americans have similar mortality but greater functional decline than whites after hospitalization for heart failure. This outcome is not explained by clinical, socioeconomic, access-to-care or quality-of-care differences.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living
  • African Continental Ancestry Group*
  • Aged
  • Analysis of Variance
  • Cohort Studies
  • European Continental Ancestry Group*
  • Female
  • Health Services Accessibility
  • Heart Failure / ethnology*
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Hospitalization
  • Humans
  • Income
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Proportional Hazards Models
  • Prospective Studies
  • Quality of Health Care
  • Socioeconomic Factors