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Ethnicity and variation in prognosis for patients newly hospitalised for heart failure: a matched historical cohort study
  1. J D Newton1,
  2. H M Blackledge2,
  3. I B Squire1
  1. 1University of Leicester Department of Cardiovascular Sciences, Leicester, UK
  2. 2Department of Health Informatics, Leicestershire, Northamptonshire & Rutland Strategic Health Authority, Leicester, UK
  1. Correspondence to:
    Dr Iain Squire
    University of Leicester Department of Cardiovascular Sciences, Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK;


Objectives: To compare mortality and factors predictive for outcome in age matched white and South Asian cohorts after first admission for heart failure.

Design: Matched historical cohort study.

Setting: One National Health Service trust comprising three acute care hospitals.

Participants: 176 South Asian (mean age 68 (10) years, 45% women) and 352 age and sex matched white (70 (11) years, 42% women) patients hospitalised for the first time with heart failure.

Main outcome measures: All cause survival, measures of disease severity, and the association of clinical variables with outcome.

Results: Compared with white patients, South Asian patients had similar rates of prior coronary heart disease but more often had prior hypertension (45% v 33%, p  =  0.006) and diabetes (46% v 18%, p < 0.0001). Atrial fibrillation (15% v 31%, p  =  0.0002) and prior diuretic use (39% v 48%, p  =  0.041) were less common among South Asians. Left ventricular function was more often preserved (38% v 23%, p  =  0.002) and less often severely impaired (18% v 28%, p  =  0.025) among South Asians. During follow up (range 520–1880 days) 73 of 176 (41.2%) South Asian and 167 of 352 (47.4%) white patients died. South Asian ethnicity was associated with lower all cause mortality (odds ratio 0.71, 95% confidence interval 0.53 to 0.96, p  =  0.02). Other predictors of outcome (admission age, lower systolic blood pressure, higher creatinine, higher plasma glucose, and lower haemoglobin) were similar in each cohort.

Conclusions: At first hospitalisation, heart failure appears less advanced in South Asians, among whom diabetes and hypertension are more prevalent. Survival is better for South Asian than for white patients. Higher glucose and lower haemoglobin at admission provide useful prognostic information in heart failure.

  • CHARM, candesartan in heart failure assessment of reduction in mortality and morbidity
  • CHD, coronary heart disease
  • CHF, chronic heart failure
  • LV, left ventricular
  • RENAISSANCE, randomized etanercept North American strategy to study antagonism of cytokines
  • ethnicity
  • heart failure
  • prognosis

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  • Published Online First 29 March 2005

  • Funding: JDN is supported by the Nuffield Hospital, Leicester. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests statement: The authors have no competing interests to declare.