Journal of Immigrant and Minority Health

, Volume 17, Issue 1, pp 139–147 | Cite as

Heart Failure Outcomes Based on Race and Gender of Patients in a Medically Undeserved Area

Original Paper

Abstract

The purpose of this descriptive study was to investigate changes in quality of life (QoL), disease severity and exercise tolerance of heart failure (HF) patients in a medically underserved clinic based on race and gender. Despite advances in the treatment of HF over the past decade, incidence, morbidity and mortality for patients continue to rise while QoL declines. HF is common in African-Americans and women; however, there is limited research focusing on race and gender variables. Health related QoL, disease severity measured by B-type natriuretic peptide blood test (BNP) and ejection fraction (EF), and exercise tolerance measured by six minute walk test (6MWT) were assessed at admission and at 6 months in a convenience sample of 53 patients. Variables were compared by race and gender. The sample was 67.9 % African American and 62.3 % male. Men had greater improvements than women in QoL, BNP, and EF, while women had greater improvements in the 6MWT. African Americans had greater improvements than Whites in all four variables. Even in the presence of disease severity in patients with New York Heart Association (NYHA) Class III and IV HF, there were significant improvements in QoL, BNP, HF outcomes demonstrating the importance of developing culturally sensitive and gender-specific treatment plans.

Keywords

B-type natriuretic peptide blood test Ejection fraction Gender Heart failure Quality of life Race 

References

  1. 1.
    Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD. Heart disease and stroke statistics-2011 update: a report from the American Heart Association. Circulation. 2011;123:18–209.CrossRefGoogle Scholar
  2. 2.
    Zambroski CH, Moser DK, Bhat G, Ziegler C. Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure. Eur J Cardiovasc Nurs. 2005;4(3):198–206.PubMedCrossRefGoogle Scholar
  3. 3.
    Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL. Symptom distress and quality of life in patients with advanced congestive heart failure. J Pain Symptom Manag. 2008;35(6):594–603.CrossRefGoogle Scholar
  4. 4.
    Stromberg A, Martensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nurs. 2003;2(1):7–18.PubMedCrossRefGoogle Scholar
  5. 5.
    Bahrami H, Kronmal R, Bluemke DA, et al. Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis. Arch Intern Med. 2008;168(19):2138–45.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Yancy CW, Strong M. The natural history, epidemiology, and prognosis of heart failure in African Americans. Congest Heart Fail. 2004;10:15–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Bibbins-Domingo K, Pletcher MJ, Lin F. Racial differences in incident heart failure among young adults. N Engl J Med. 2009;360(12):1179–90.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Hsich EM, Piña IleanaL. Heart failure in women, a need for perspective data. J Am Coll Cardiol. 2009;54:491–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Lund L, Mancini D. Heart failure in women. Med Clin North Am. 2004;88:1321–45.PubMedCrossRefGoogle Scholar
  10. 10.
    US Department of Health and Human Services: Health Resources and Services Administration. Find shortage areas: MUA/P by State and County. 2010. http://muafind.hrsa.gov/. Accessed May 3, 2012.
  11. 11.
    NC Department of Health and Human Services: Division of Medical Assistance. County specific snapshots for NC medicaid services. 2010. http://www.dhhs.state.nc.us/dma/countyreports/. Accessed May 3, 2011.
  12. 12.
    United States Department of Agriculture; Economic Research Service. Data sets: county typology codes. 2004. May 8 2011.Google Scholar
  13. 13.
    Rector TS, Kubo SH, Cohn JN. Patients’ self-assessment of their congestive heart failure. Part 2: content, reliability and validity of a new measure: The Minnesota living with heart failure questionnaire. Heart Fail. 1987;3:198–209.Google Scholar
  14. 14.
    Bennett SJ, Oldridge NB, Eckert GJ, et al. Comparison of quality of life measures in heart failure. Nurs Res. 2003;52(4):207–16.PubMedCrossRefGoogle Scholar
  15. 15.
    Heo S, Moser DK, Riegel B, Hall LA, Christman N. Testing the psychometric properties of the Minnesota living with heart failure questionnaire. Nurs Res. 2005;54(4):265–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Bennett JA, Riegel B, Bittner V, Nichols J. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung. 2002;31(4):262–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. CMAJ. 1985;132:919–23.Google Scholar
  18. 18.
    Fonarow GC, Peacock WF, Phillips CO, Givertz MM, Lopatin M. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol. 2007;49(19):1943–50.PubMedCrossRefGoogle Scholar
  19. 19.
    Nohria A, Mielniczuk LM, Stevenson LW. Evaluation and monitoring of patients with acute heart failure syndromes. Am J Cardiol. 2005;96(6):32–40.CrossRefGoogle Scholar
  20. 20.
    Latini R, Masson S, Wong M. Incremental prognostic value of changes in B-type natriuretic peptide in heart failure. Am J Med. 2006;119(1):23–30.CrossRefGoogle Scholar
  21. 21.
    Zhang L, Dokainish H. Echocardiography in the assessment of heart failure. Minerva Cardioangiol. 2009;7(4):457–66.Google Scholar
  22. 22.
    SPSS for Windows, Rel. 18.0.0. [computer program]. Chicago: SPSS, Inc.; 2009.Google Scholar
  23. 23.
    Hebert K, Lopez B, Horswell R. The impact of a standardized disease management program on race/ethnicity and gender disparities in care and mortality. J Health Care Poor Underserved. 2010;21(1):264–76.PubMedCrossRefGoogle Scholar
  24. 24.
    US Department of Health and Human Services: 2011 National Survey on Drug and Health Use. http://store.samhsa.gov/home. Accessed May 15, 2013.
  25. 25.
    Lam CS, Lyass A, Kraigher-Krainer E, et al. Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community. Circulation. 2011;124(1):24–30.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Azevedo A, Bettencourt P, Alvelos M. Health-related quality of life and stages of heart failure. Int J Cardiol. 2008;129(2):238–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Heo S, Moser DK, Widener J. Gender differences in the effects of physical and emotional symptoms on health-related quality of life in patients with heart failure. Eur J Cardiovasc Nurs. 2007;6(2):146–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Lesman-Leegte I, Jaarsma T, Coyne JC, Hillege HL, Van Veldhuisen DJ, Sanderman R. Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls. J Card Fail. 2009;15(1):17–23.PubMedCrossRefGoogle Scholar
  29. 29.
    Riedinger M, Dracup K, Brecht M. A comparative study of quality of life: women with heart failure versus normative groups and patients with other chronic conditions. Amer J Crit Care. 2002;11(3):211–9.Google Scholar
  30. 30.
    Riegel B, Moser DK, Rayens MK. Ethnic differences in quality of life in persons with heart failure. J Card Fail. 2008;14(1):41–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Hobbs RE. Using BNP to diagnose, manage, and treat heart failure. Cleve Clin J Med. 2003;70(4):333.PubMedCrossRefGoogle Scholar
  32. 32.
    Cardarelli R, Lumicao TG. B-type natriuretic peptide: a review of its diagnostic, prognostic and therapeutic monitoring value in heart failure for primary care physicians. J Am Board Family Pract. 2003;16:327–33.CrossRefGoogle Scholar
  33. 33.
    Troughton MB, Frampton CM, Yandle TG, Espine EA, Nicholls MG, Richards M. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide. Lancet. 2000;355(9210):1126–30.PubMedCrossRefGoogle Scholar
  34. 34.
    Rame JE, Drazner MH, Post W, et al. Corin I555 (P568) allele is associated with enhanced cardiac hypertrophic response to increased systemic afterload. Hypertension. 2007;49:857–64.PubMedCrossRefGoogle Scholar
  35. 35.
    Daniels LB, Bhalla V, Clopton P, Hollander JE, Guss D, McCullough PA, et al. B-type natriuretic peptide (BNP) levels and ethnic disparities in perceived severity of heart failure: results from the rapid emergency department heart failure outpatient trial (REDHOT) multicenter study of BNP levels and emergency department decision making in patients presenting with shortness of breath. J Card Fail. 2006;12(4):281–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Najjar SS, Schulman SP, Gerstenblith G, Fleg JL, Kass DA, O’Connor F, et al. Age and gender affect ventricular-vascular coupling during aerobic exercise. J Am Coll Cardiol. 2004;44:611–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Heart Failure Society of America, Lindenfeld J, Albert NM, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail 2010;16:1–194. Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Walden UniversityMinneapolisUSA
  2. 2.Care Improvement PlusFrazerUSA

Personalised recommendations