Prognosis for South Asian and white patients newly admitted to hospital with heart failure in the United Kingdom: historical cohort study

Abstract

Objectives: To compare patterns of admission to hospital and prognosis in white and South Asian patients newly admitted with heart failure, and to evaluate the effect of personal characteristics and comorbidity on outcome.

Design: Historical cohort study.

Setting: UK district health authority (population 960,000).

Participants: 5789 consecutive patients newly admitted with heart failure.

Main outcome measures: Population admission rates, incidence rates for first admission with heart failure, survival, and readmission rates.

Results: When compared with the white population, South Asian patients had significantly higher age adjusted admission rates (rate ratio 3.8 for men and 5.2 for women) and hospital incidence rates (2.2 and 2.9). Among 5789 incident cases of heart failure, South Asian patients were younger and more often male than white patients (70 (SD 0.6) v 78 (SD 0.1) years and 56.5% (190/336) v 49.3% (2494/5057)). South Asian patients were also more likely to have previous myocardial infarction (10.1% (n = 34) v 5.5% (n = 278)) or concomitant myocardial infarction (18.8% (n = 63) v 10.7% (n = 539)) or diabetes (45.8% (n = 154) v 16.2% (n = 817), all P < 0.001). A trend was shown to longer unadjusted survival for both sexes among South Asian patients. After adjustment for covariables, South Asian patients had a significantly lower risk of death (hazard ratio 0.82, 95% confidence interval 0.68 to 0.99) and a similar probability of death or readmission (0.96, 0.81 to 1.09) compared with white patients.

Conclusions: Population admission rates for heart failure are higher among South Asian patients than white patients in Leicestershire. At first admission South Asian patients were younger and more often had concomitant diabetes or acute ischaemic heart disease than white patients. Despite major differences in personal characteristics and risk factors between white and South Asian patients, outcome was similar, if not better, in South Asian patients.

Fig 1

Ratios of age standardised admission (heart failure in any position) and incidence rates of first admission for heart failure for South Asian and white patients (95% confidence intervals), 1998-2001

Fig 2

Survival model for South Asian and white patients in cohort of new cases diagnosed with heart failure in hospital between 1 April 1998 and 31 March 2001