Mortality After Hospitalization for Heart Failure in Blacks Compared with Whites

Heart Failure (HF) disproportionately affects black compared with white Americans and overall mortality from HF is higher among blacks. Paradoxically, mortality rates after a hospitalization for HF are lower in black compared with white patients. These racial differences may reflect hospital, physician, and patient factors and may have implications for comparative hospital profiles. We identified published studies reporting post-hospitalization mortality for black and white patients with a discharge diagnosis of HF and conducted random-effects meta-analyses with the outcome of all-cause mortality. We included 29 cohorts of hospitalized black and white patients with HF. Unadjusted mean mortality rates after HF hospitalization for black and white patients, respectively, were 6% and 9% (in-hospital), 6% and 10% (30-day mortality), 10% and 15% (60-180 day mortality), 28% and 34% (1 year mortality) and 41% and 47% (mortality after 1 year). Unadjusted combined odds ratios (OR) for mortality in black compared with white patients ranged from 0.48 in-hospital (95% CI 0.45-0.51) to 0.77 after more than 1 year follow-up (95% CI 0.75-0.79). In meta-analyses using adjusted data, the combined OR was 0.68 for short-term mortality (95% CI 0.63 – 0.74), and the combined hazard ratio was 0.84 for long-term mortality (95% CI 0.77-0.91). In conclusion, mortality after hospitalization for HF was 32% lower in short-term follow-up and 16% lower in long-term follow-up for black compared with white patients. The mortality differences imply unmeasured differences by race in clinical severity of illness at hospital admission and may lead to biased hospital mortality profiles.