Gender differences and practice implications of risk factors for frequent hospitalization for heart failure in an urban center serving predominantly African-American patients

To identify the clinical correlates of recurrent heart failure hospitalizat ion in a large urban hospital serving predominately African-American patien ts, and to provide further insight into modifiable risks for heart failure readmissions, a retrospective period prevalence review of the records of al l adult patients admitted with a primary diagnosis of heart failure (Intern ational Classification of Diseases-9 code 428.0) between January and Decemb er 1995 was performed,The main outcome was the number of heart failure hosp italizations over 12 months. Twelve hundred patients were identified. Mean age was 64 +/- 16 years, 94% were black, 57% were women, and 40% were great er than or equal to 65 years old. Ninety-eight percent had a history of sys temic hypertension and 55% had uncontrolled hypertension. Other comorbiditi es were left ventricular (LV) hypertrophy (64%), coronary artery disease (5 2%), and tobacco abuse (28%). Sixty-five percent of patients were on angiot ensin-converting (ACE) inhibitors, 51% on calcium antagonists, and 8% on be ta blockers, Most patients had suboptimal dosing of ACE inhibitors and ther e was inappropriate use of calcium antagonists in 56% of patients with mode rate or severe systolic dysfunction. Diabetes mellitus and echocardiographi c wall motion abnormality were independently associated with frequent admis sions for women but not for men. Medication-related increase in heart failu re hospitalization was seen For calcium antagonists in patients with severe LV dysfunction (odds ratio 2.24, 95% confidence intervals 1.0 to 5.03; p < 0.03), Uncontrolled hypertension, underdosing of ACE inhibitors, and overus e of calcium antagonists in patients with significant LV dysfunction are po tential targets for intervention. (C) 1999 by Excerpta Medica, Inc.