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Older subjects make racial implications unclear
A study by the Centers for Disease Control and Prevention (CDC) in Atlanta paints a dark picture for elderly patients hospitalized for their first time for heart failure. Among patients who survive to be discharged, a third die within a year. And six years after the hospitalization, less than a fifth of the men and a quarter of the women will still be alive.
Lead researcher Janet B. Croft, PhD, says it’s important to consider this data set in the study:
This selection of the data set could explain why black patients seemed to do better than white patients, she says. For this group, white men had a 10% greater risk of mortality than black men.
After six years from hospital discharge, the statistics show:
Croft says, in general, blacks tend to develop CHF at a younger age than whites. It is possible that by looking only at older CHF patients who were healthy enough to stay out of the hospital until they were older than 67, the black patients could have been in better physical condition than white patients. The typical black CHF patient may have been hospitalized already (and therefore ineligible for the study) or have died before reaching the study age.
"There has already been a mortality selection," adds George A. Mensah, MD, chief of cardiology and the head of cardiovascular care at the Veterans Affairs Medical Center in Augusta, GA. As patients live to be much older, he says, the racial differences often disappear.
But even though patients lived long enough to be in the study, the chance to survive another six years is not good.
"It may have seemed that black patients did better," Croft adds, "but survival is still bad for everyone."
Croft says greater use of ACE inhibitors and beta-blockers could help keep patients in better control of their heart failure. Using the drugs after patients have a heart attack or develop hypertension could help prevent heart failure from developing.
"That’s the main message we at the CDC are trying to give," she says, adding the agency is now working to educate physicians about using these medications in a programs with managed care providers and state Peer Review Organizations associated with the Health Care Finance Administration.
"Almost 50% of heart failure patient hospitalizations could be prevented with the right medication," she says.