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Published in: Journal of Immigrant and Minority Health 1/2015

01-02-2015 | Original Paper

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

Authors: Linda L. Steele, James R. Steele

Published in: Journal of Immigrant and Minority Health | Issue 1/2015

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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.
Literature
1.
go back to reference 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.CrossRef 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.CrossRef
2.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
3.
go back to reference 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.CrossRef 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.CrossRef
4.
go back to reference Stromberg A, Martensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nurs. 2003;2(1):7–18.PubMedCrossRef Stromberg A, Martensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nurs. 2003;2(1):7–18.PubMedCrossRef
5.
go back to reference 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.PubMedCentralPubMedCrossRef 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.PubMedCentralPubMedCrossRef
6.
go back to reference Yancy CW, Strong M. The natural history, epidemiology, and prognosis of heart failure in African Americans. Congest Heart Fail. 2004;10:15–22.PubMedCrossRef Yancy CW, Strong M. The natural history, epidemiology, and prognosis of heart failure in African Americans. Congest Heart Fail. 2004;10:15–22.PubMedCrossRef
8.
go back to reference Hsich EM, Piña IleanaL. Heart failure in women, a need for perspective data. J Am Coll Cardiol. 2009;54:491–8.PubMedCrossRef Hsich EM, Piña IleanaL. Heart failure in women, a need for perspective data. J Am Coll Cardiol. 2009;54:491–8.PubMedCrossRef
10.
go back to reference 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. 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.
12.
go back to reference United States Department of Agriculture; Economic Research Service. Data sets: county typology codes. 2004. May 8 2011. United States Department of Agriculture; Economic Research Service. Data sets: county typology codes. 2004. May 8 2011.
13.
go back to reference 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. 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.
14.
go back to reference Bennett SJ, Oldridge NB, Eckert GJ, et al. Comparison of quality of life measures in heart failure. Nurs Res. 2003;52(4):207–16.PubMedCrossRef Bennett SJ, Oldridge NB, Eckert GJ, et al. Comparison of quality of life measures in heart failure. Nurs Res. 2003;52(4):207–16.PubMedCrossRef
15.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
16.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
17.
go back to reference 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. 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.
18.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
19.
go back to reference Nohria A, Mielniczuk LM, Stevenson LW. Evaluation and monitoring of patients with acute heart failure syndromes. Am J Cardiol. 2005;96(6):32–40.CrossRef Nohria A, Mielniczuk LM, Stevenson LW. Evaluation and monitoring of patients with acute heart failure syndromes. Am J Cardiol. 2005;96(6):32–40.CrossRef
20.
go back to reference 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.CrossRef 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.CrossRef
21.
go back to reference Zhang L, Dokainish H. Echocardiography in the assessment of heart failure. Minerva Cardioangiol. 2009;7(4):457–66. Zhang L, Dokainish H. Echocardiography in the assessment of heart failure. Minerva Cardioangiol. 2009;7(4):457–66.
22.
go back to reference SPSS for Windows, Rel. 18.0.0. [computer program]. Chicago: SPSS, Inc.; 2009. SPSS for Windows, Rel. 18.0.0. [computer program]. Chicago: SPSS, Inc.; 2009.
23.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
25.
go back to reference 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.PubMedCentralPubMedCrossRef 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.PubMedCentralPubMedCrossRef
26.
go back to reference Azevedo A, Bettencourt P, Alvelos M. Health-related quality of life and stages of heart failure. Int J Cardiol. 2008;129(2):238–44.PubMedCrossRef Azevedo A, Bettencourt P, Alvelos M. Health-related quality of life and stages of heart failure. Int J Cardiol. 2008;129(2):238–44.PubMedCrossRef
27.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
28.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
29.
go back to reference 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. 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.
30.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
31.
go back to reference Hobbs RE. Using BNP to diagnose, manage, and treat heart failure. Cleve Clin J Med. 2003;70(4):333.PubMedCrossRef Hobbs RE. Using BNP to diagnose, manage, and treat heart failure. Cleve Clin J Med. 2003;70(4):333.PubMedCrossRef
32.
go back to reference 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.CrossRef 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.CrossRef
33.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
34.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
35.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
36.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
37.
go back to reference 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. 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.
Metadata
Title
Heart Failure Outcomes Based on Race and Gender of Patients in a Medically Undeserved Area
Authors
Linda L. Steele
James R. Steele
Publication date
01-02-2015
Publisher
Springer US
Published in
Journal of Immigrant and Minority Health / Issue 1/2015
Print ISSN: 1557-1912
Electronic ISSN: 1557-1920
DOI
https://doi.org/10.1007/s10903-013-9892-7

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