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Blacks hospitalized for heart failure more often

By Valerie DeBenedette

NEW YORK (Reuters Health) - Black patients with heart failure were more likely to be hospitalized for complications of the disease than whites with heart failure, in a new study.

They also tended to be younger and heavier, were less in shape and were more likely to have other significant health problems such as diabetes or high blood pressure.

However, black heart failure patients were just as likely to die from heart-related causes as whites. Researchers said weight and coexisting diseases may play a larger role in the risk of death than race.

"The main difference between the two groups was in rehospitalization risk," said Dr. Robert Mentz, a cardiology researcher at Duke University in Durham, North Carolina, who led the new study.

However, it was unclear why blacks with heart failure were hospitalized more often, he added.

The findings are based on a second look at data from a larger study, known as HF-ACTION, a controlled trial designed to see if exercise training helps people with heart failure live longer. That study compared standard care for patients with heart failure to standard care plus an exercise training program involving a treadmill or stationary bicycle.

More than 2,300 patients in the United States, Canada and France participated in HF-ACTION.

At the start of the study, blacks were in poorer physical shape than whites, based on a standard walking test. They could walk an average of 348 meters in six minutes, compared to 383 meters for white patients.

For the current report, the original study participants were followed for about two and a half years.

During that time, about 18 percent of black patients died and 67 percent were hospitalized. About 16 percent of white patients died and 62 percent were hospitalized.

After accounting for other differences between patients - including their health at the start of the study - the researchers found black people were 58 percent more likely to be hospitalized for heart failure, in particular, than whites.

EXERCISE BENEFITS

Dr. Gregg Fonarow, who studies cardiovascular medicine at the University of California, Los Angeles, called the original differences in exercise abilities by race "striking."

Usually younger people do better on exercise tests than older people. In this group blacks were generally younger than whites, but still could not walk as far, Fonarow, a spokesperson for the American Heart Association and a principal investigator on the HF-ACTION trial, told Reuters Health.

The new analysis, published in the American Heart Journal, showed both blacks and whites improved their fitness with the supervised program.

After three months of exercise therapy, black patients were able to walk about 11 meters further in six minutes and whites were able to walk about 26 meters further.

"Both groups had similar improvement in response to exercise training," Fonarow said. "Regardless of race and ethnicity, exercise training should be considered."

Exercise is known to be effective in moderating both diabetes and high blood pressure as well as helping improve heart failure, Mentz said. Regular mild aerobic exercise is considered to be safe for patients with heart failure, with their doctor's approval.

"We really could do better for our patients by modifying these lifestyles and behaviors," Mentz said.

SOURCE: http://bit.ly/164acZL American Heart Journal, online July 15, 2013.

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