Ethnicity and Heart Failure Outcomes in England: Role of Specialist Care in a Universal Health System.

Abstract

Poorer cardiovascular outcomes among ethnic minorities have been reported, particularly during the COVID-19 pandemic. However, the relationship between ethnicity and quality of care after hospitalization for heart failure (HF) and long-term outcomes is largely unknown. The aim of this analysis is to investigate quality of care and longer-term outcomes of patients hospitalized with acute HF according to ethnicity. Routinely collected data for England from the National Heart Failure Audit, National Health Service Hospital Episode Statistics, and Office for National Statistics death register from 2018 to 2023 were used to investigate the quality of care and outcomes after hospitalization with HF according to ethnicity. National Heart Failure Audit data for 239,890 patients admitted with HF were grouped by ethnicity as White (215,800), Black (6,610), Asian (12,940), and mixed/other (4,540), with median ages of 81 years (IQR: 73-88 years),75 years (IQR: 60-84 years), 77 years (IQR: 67-84 years), and 75 years (IQR: 61-84 years), respectively. Overall, patients had a median of 3 comorbidities (IQR: 2-4 comorbidities), with Asians having the greatest number. About 50% of patients had HF with reduced ejection fraction in all ethnic groups. For HF with reduced ejection fraction, White patients were least likely to be discharged on guideline-recommended therapies. Over a median follow-up of 68 weeks (IQR: 20-142 weeks), 122,980 (57%) White patients died, as did 2,860 (43%) Black patients, 6,270 (48%) Asian patients, and 1,900 (42%) patients of other/mixed ethnicity. About 90% of deaths were due to cardiovascular or respiratory causes. After adjusting for age, sex, socioeconomic factors, and variables associated with HF severity, all ethnic groups had lower mortality compared with White patients, including those who were Black (HR: 0.81; 95% CI: 0.78-0.84), Asian (HR: 0.77; 95% CI: 0.75-0.79), or from mixed/other ethnic groups (HR: 0.72; 95% CI: 0.69-0.75). In a universal health care system, treating an ethnically diverse population hospitalized for HF, non-White patients received better pharmacological management, which was associated with better long-term outcomes.