Whites Die of Heart Failure More than Blacks when Access to Care Equal

More Caucasians than African-Americans may die of heart failure if both groups have equal access to health care, reports a Baylor College of Medicine study.

"It is commonly assumed that poor access to care and lack of follow up contribute to differences between blacks and whites in outcomes for congestive heart failure," said Dr. Anita Deswal, professor of medicine at Baylor. "However, when you take access to care out of the equation, blacks actually die of heart failure at a lesser rate than whites."

In recent years, blacks have become a target of heart disease awareness campaigns by advocacy groups such as the American Heart Association. The ethnic group is considered to be at higher risk for heart disease than whites – black men die of cardiovascular disease at a rate 50 percent higher than white men, and black women at a rate of 65 percent higher than white women.

However, Baylor researchers found that blacks with congestive heart failure had a better 30-day survival after hospital admission as well as a better one-year survival following discharge from the hospital. A year after discharge, 23.9 percent of whites and 20.7 percent of blacks had died. The study tracked 22,000 congestive heart failure patients, 17,000 whites and 5,000 blacks, for two years.

"The results were definitely a surprise to us," said Dr. Deswal, principal investigator of the study. "Future studies will provide more insight into reasons behind the difference in mortality, particularly the specific causes of congestive heart failure in individual cases."

Nearly 5 million Americans are currently living with congestive heart failure, with 550,000 new cases diagnosed each year. The disease weakens the heart, so that it cannot pump enough blood to the lungs and the rest of the body. Usually the heart has been weakened over time by an underlying problem, such as clogged arteries and high blood pressure.

The study collected data from heart failure patients at Veterans Affairs hospitals nationwide. VA hospitals are considered equal access care settings because patients do not need health insurance to receive treatment.

"However, even in an ‘equal access’ setting of the VA, blacks appear to have a greater dependency on episodic or fragmented care, such as going to the emergency room," Dr. Deswal said.

The study advocated developing strategies to better coordinate the outpatient care in blacks with congestive heart failure in order to improve the quality of their care and reduce the number of emergency room visits or hospitalizations.

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©2006 Texas Medical Center

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