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

Non-White patients hospitalized with heart failure had lower adjusted mortality compared to White patients across all ethnic groups.

• After adjusting for age, sex, socioeconomic factors, and variables associated with HF severity, Black patients had HR: 0.81 (95% CI: 0.78-0.84), Asian patients had HR: 0.77 (95% CI: 0.75-0.79), and mixed/other ethnic groups had HR: 0.72 (95% CI: 0.69-0.75) compared to White patients.
• Over a median follow-up of 68 weeks (IQR: 20-142 weeks), 57% of White patients died, compared to 43% of Black patients, 48% of Asian patients, and 42% of mixed/other ethnicity patients.
• About 90% of deaths were due to cardiovascular or respiratory causes.

White patients with heart failure with reduced ejection fraction were least likely to be discharged on guideline-recommended therapies compared to non-White ethnic groups.

• This finding applied specifically to patients with HF with reduced ejection fraction (HFrEF).
• Non-White patients received better pharmacological management, which was associated with better long-term outcomes.
• About 50% of patients had HFrEF in all ethnic groups.

The study population of 239,890 patients hospitalized with heart failure showed significant demographic differences across ethnic groups, particularly in age.

• White patients: n=215,800, median age 81 years (IQR: 73-88 years).
• Black patients: n=6,610, median age 75 years (IQR: 60-84 years).
• Asian patients: n=12,940, median age 77 years (IQR: 67-84 years).
• Mixed/other patients: n=4,540, median age 75 years (IQR: 61-84 years).
• Data were drawn from the National Heart Failure Audit, NHS Hospital Episode Statistics, and Office for National Statistics death register from 2018 to 2023.

Asian patients had the greatest number of comorbidities among all ethnic groups.

• Overall, patients had a median of 3 comorbidities (IQR: 2-4 comorbidities).
• Asian patients had the greatest number of comorbidities compared to White, Black, and mixed/other ethnic groups.
• Despite having more comorbidities, Asian patients still had lower adjusted mortality (HR: 0.77; 95% CI: 0.75-0.79) compared to White patients.

Poorer cardiovascular outcomes among ethnic minorities have been reported particularly during the COVID-19 pandemic, but the relationship between ethnicity and quality of care after hospitalization for heart failure was largely unknown prior to this study.

• The study investigated quality of care and longer-term outcomes of patients hospitalized with acute HF according to ethnicity using routinely collected data for England.
• The study period spanned 2018 to 2023, encompassing the COVID-19 pandemic period.
• The analysis used a universal health care system (NHS England) context.