Racial differences and mortality risk in patients with heart failure and hyponatremia
Hyponatremia is a well-established poor prognostic marker in patients with heart failure. Whether the mortality risk is comparable among different races of patients with heart failure and hyponatremia is unknown. Consecutive patients admitted with acute decompensated heart failure and an admission s...
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| Veröffentlicht in: | PloS one 2019-06, Vol.14 (6), p.e0218504-e0218504 |
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| creator | Miles, Jeremy A Quispe, Renato Mehlman, Yonatan Patel, Kavisha Lama Von Buchwald, Claudia You, Jee Young Sokol, Seth Faillace, Robert T |
| description | Hyponatremia is a well-established poor prognostic marker in patients with heart failure. Whether the mortality risk is comparable among different races of patients with heart failure and hyponatremia is unknown.
Consecutive patients admitted with acute decompensated heart failure and an admission sodium level |
| doi_str_mv | 10.1371/journal.pone.0218504 |
| format | Article |
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Consecutive patients admitted with acute decompensated heart failure and an admission sodium level<135 mEq/L from 1/1/2001 through 12/31/10 were identified. Patients were divided into four groups based on self-reported race: white, African American, Hispanic and other. African Americans were used as the reference group for statistical analysis. The primary outcome was all-cause mortality.
We included 4,343 patients, from which 1,356 (31%) identified as white, 1,248 (29%) as African American, 780 (18%) as Hispanic and 959 (22%) as other. During a median follow-up of 23 months, a total of 2,384 patients died: 678 were African American, 820 were white, 298 were Hispanic and 588 were other. After adjusting for baseline demographics, comorbidities and medication use, Hispanic patients had a 45% less risk of death as compared to African Americans (HR .55, CI .48-.64, p<0.05). There was no difference in mortality between white and African American patients (HR 1.04, CI .92-1.2, p = 0.79).
Hispanic patients admitted for heart failure and who were hyponatremic on admission had an independent lower risk of mortality compared to other groups. These findings may be due to the disparate activity of the renin-angiotensin-aldosterone system among various racial groups. This observational study is hypothesis generating and suggests that treatment of patients with heart failure and hyponatremia should perhaps be focused more on renin-angiotensin-aldosterone system reduction in certain racial groups, yet less in others.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0218504</identifier><identifier>PMID: 31216316</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>African Americans ; African Americans - genetics ; Aged ; Aldosterone ; Analysis ; Angiotensin ; Angiotensins ; Atrial Fibrillation - genetics ; Atrial Fibrillation - mortality ; Atrial Fibrillation - physiopathology ; Blood pressure ; Cardiac arrhythmia ; Cardiac patients ; Cardiology ; Cardiovascular disease ; Comorbidity ; Congestive heart failure ; Demographics ; Demography ; Enzymes ; Ethnicity ; European Continental Ancestry Group - genetics ; Female ; Glucocorticoids ; Heart ; Heart attacks ; Heart failure ; Heart Failure - genetics ; Heart Failure - mortality ; Heart Failure - physiopathology ; Hispanic Americans ; Hispanic Americans - genetics ; Hispanic people ; Hospitalization ; Hospitals ; Humans ; Hyponatremia ; Hyponatremia - genetics ; Hyponatremia - mortality ; Hyponatremia - physiopathology ; Kidney diseases ; Medical prognosis ; Medical research ; Medical schools ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Minority & ethnic groups ; Mortality ; Myocardial Infarction - genetics ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Patients ; People and Places ; Peripheral Vascular Diseases - genetics ; Peripheral Vascular Diseases - mortality ; Peripheral Vascular Diseases - physiopathology ; Prognosis ; Race ; Racial differences ; Racism ; Renin ; Retrospective Studies ; Risk ; Risk Factors ; Sodium ; Statistical analysis ; Steroids (Organic compounds) ; Studies ; Survival analysis ; Systematic review ; White people</subject><ispartof>PloS one, 2019-06, Vol.14 (6), p.e0218504-e0218504</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Miles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Miles et al 2019 Miles et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-2a211e31e88eb7e973029a97e2756d565c27e4f560caab98bd726f2e90260bb43</citedby><cites>FETCH-LOGICAL-c692t-2a211e31e88eb7e973029a97e2756d565c27e4f560caab98bd726f2e90260bb43</cites><orcidid>0000-0002-8078-1753</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583993/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583993/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31216316$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Miles, Jeremy A</creatorcontrib><creatorcontrib>Quispe, Renato</creatorcontrib><creatorcontrib>Mehlman, Yonatan</creatorcontrib><creatorcontrib>Patel, Kavisha</creatorcontrib><creatorcontrib>Lama Von Buchwald, Claudia</creatorcontrib><creatorcontrib>You, Jee Young</creatorcontrib><creatorcontrib>Sokol, Seth</creatorcontrib><creatorcontrib>Faillace, Robert T</creatorcontrib><title>Racial differences and mortality risk in patients with heart failure and hyponatremia</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Hyponatremia is a well-established poor prognostic marker in patients with heart failure. Whether the mortality risk is comparable among different races of patients with heart failure and hyponatremia is unknown.
Consecutive patients admitted with acute decompensated heart failure and an admission sodium level<135 mEq/L from 1/1/2001 through 12/31/10 were identified. Patients were divided into four groups based on self-reported race: white, African American, Hispanic and other. African Americans were used as the reference group for statistical analysis. The primary outcome was all-cause mortality.
We included 4,343 patients, from which 1,356 (31%) identified as white, 1,248 (29%) as African American, 780 (18%) as Hispanic and 959 (22%) as other. During a median follow-up of 23 months, a total of 2,384 patients died: 678 were African American, 820 were white, 298 were Hispanic and 588 were other. After adjusting for baseline demographics, comorbidities and medication use, Hispanic patients had a 45% less risk of death as compared to African Americans (HR .55, CI .48-.64, p<0.05). There was no difference in mortality between white and African American patients (HR 1.04, CI .92-1.2, p = 0.79).
Hispanic patients admitted for heart failure and who were hyponatremic on admission had an independent lower risk of mortality compared to other groups. These findings may be due to the disparate activity of the renin-angiotensin-aldosterone system among various racial groups. This observational study is hypothesis generating and suggests that treatment of patients with heart failure and hyponatremia should perhaps be focused more on renin-angiotensin-aldosterone system reduction in certain racial groups, yet less in others.</description><subject>African Americans</subject><subject>African Americans - genetics</subject><subject>Aged</subject><subject>Aldosterone</subject><subject>Analysis</subject><subject>Angiotensin</subject><subject>Angiotensins</subject><subject>Atrial Fibrillation - genetics</subject><subject>Atrial Fibrillation - mortality</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Blood pressure</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac patients</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Comorbidity</subject><subject>Congestive heart failure</subject><subject>Demographics</subject><subject>Demography</subject><subject>Enzymes</subject><subject>Ethnicity</subject><subject>European Continental Ancestry Group - genetics</subject><subject>Female</subject><subject>Glucocorticoids</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - genetics</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Hispanic Americans</subject><subject>Hispanic Americans - genetics</subject><subject>Hispanic people</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyponatremia</subject><subject>Hyponatremia - genetics</subject><subject>Hyponatremia - mortality</subject><subject>Hyponatremia - physiopathology</subject><subject>Kidney diseases</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Minority & ethnic groups</subject><subject>Mortality</subject><subject>Myocardial Infarction - genetics</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Patients</subject><subject>People and Places</subject><subject>Peripheral Vascular Diseases - genetics</subject><subject>Peripheral Vascular Diseases - mortality</subject><subject>Peripheral Vascular Diseases - physiopathology</subject><subject>Prognosis</subject><subject>Race</subject><subject>Racial differences</subject><subject>Racism</subject><subject>Renin</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk Factors</subject><subject>Sodium</subject><subject>Statistical analysis</subject><subject>Steroids (Organic compounds)</subject><subject>Studies</subject><subject>Survival analysis</subject><subject>Systematic review</subject><subject>White people</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNkl1v0zAYhSMEYmPwDxBEQkJw0eKvOMkN0jTxUWnSpMG4td44b1oXN-5sB-i_x22zqUW7QLlI5Dzn2O_xybKXlEwpL-mHpRt8D3a6dj1OCaNVQcSj7JTWnE0kI_zxwfdJ9iyEJSEFr6R8mp1wyqjkVJ5mN9egDdi8NV2HHnuNIYe-zVfOR7AmbnJvws_c9PkaosE-hvy3iYt8geBj3oGxg8edYrFJJ4HocWXgefakAxvwxfg-y24-f_p-8XVyefVldnF-OdGyZnHCgFGKnGJVYVNiXXLCaqhLZGUh20IWmpUoukISDdDUVdOWTHYMa8IkaRrBz7LXe9-1dUGNiQTFmOBCsqqsEjHbE62DpVp7swK_UQ6M2i04P1dpEKMtKkIqQisBvCupqEsB0BUV11SWopECtl4fx92GZoWtTml4sEemx396s1Bz90vJ5FPXPBm8Gw28ux0wRLUyQaO10KMbducWlBNOZELf_IM-PN1IzSENYPrOpX311lSdF1WaQUi5TWn6AJWeNt2VTvXpTFo_Erw_EiQm4p84hyEENft2_f_s1Y9j9u0Bmypk4yI4O0Tj-nAMij2ovQvBY3cfMiVq2_67NNS2_Wpsf5K9Oryge9Fd3flf-cr-PA</recordid><startdate>20190619</startdate><enddate>20190619</enddate><creator>Miles, Jeremy A</creator><creator>Quispe, Renato</creator><creator>Mehlman, Yonatan</creator><creator>Patel, Kavisha</creator><creator>Lama Von Buchwald, Claudia</creator><creator>You, Jee Young</creator><creator>Sokol, Seth</creator><creator>Faillace, Robert T</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-8078-1753</orcidid></search><sort><creationdate>20190619</creationdate><title>Racial differences and mortality risk in patients with heart failure and hyponatremia</title><author>Miles, Jeremy A ; Quispe, Renato ; Mehlman, Yonatan ; Patel, Kavisha ; Lama Von Buchwald, Claudia ; You, Jee Young ; Sokol, Seth ; Faillace, Robert T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-2a211e31e88eb7e973029a97e2756d565c27e4f560caab98bd726f2e90260bb43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>African Americans</topic><topic>African Americans - genetics</topic><topic>Aged</topic><topic>Aldosterone</topic><topic>Analysis</topic><topic>Angiotensin</topic><topic>Angiotensins</topic><topic>Atrial Fibrillation - genetics</topic><topic>Atrial Fibrillation - mortality</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Blood pressure</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac patients</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Comorbidity</topic><topic>Congestive heart failure</topic><topic>Demographics</topic><topic>Demography</topic><topic>Enzymes</topic><topic>Ethnicity</topic><topic>European Continental Ancestry Group - genetics</topic><topic>Female</topic><topic>Glucocorticoids</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure - genetics</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Hispanic Americans</topic><topic>Hispanic Americans - genetics</topic><topic>Hispanic people</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hyponatremia</topic><topic>Hyponatremia - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miles, Jeremy A</au><au>Quispe, Renato</au><au>Mehlman, Yonatan</au><au>Patel, Kavisha</au><au>Lama Von Buchwald, Claudia</au><au>You, Jee Young</au><au>Sokol, Seth</au><au>Faillace, Robert T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Racial differences and mortality risk in patients with heart failure and hyponatremia</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-06-19</date><risdate>2019</risdate><volume>14</volume><issue>6</issue><spage>e0218504</spage><epage>e0218504</epage><pages>e0218504-e0218504</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Hyponatremia is a well-established poor prognostic marker in patients with heart failure. Whether the mortality risk is comparable among different races of patients with heart failure and hyponatremia is unknown.
Consecutive patients admitted with acute decompensated heart failure and an admission sodium level<135 mEq/L from 1/1/2001 through 12/31/10 were identified. Patients were divided into four groups based on self-reported race: white, African American, Hispanic and other. African Americans were used as the reference group for statistical analysis. The primary outcome was all-cause mortality.
We included 4,343 patients, from which 1,356 (31%) identified as white, 1,248 (29%) as African American, 780 (18%) as Hispanic and 959 (22%) as other. During a median follow-up of 23 months, a total of 2,384 patients died: 678 were African American, 820 were white, 298 were Hispanic and 588 were other. After adjusting for baseline demographics, comorbidities and medication use, Hispanic patients had a 45% less risk of death as compared to African Americans (HR .55, CI .48-.64, p<0.05). There was no difference in mortality between white and African American patients (HR 1.04, CI .92-1.2, p = 0.79).
Hispanic patients admitted for heart failure and who were hyponatremic on admission had an independent lower risk of mortality compared to other groups. These findings may be due to the disparate activity of the renin-angiotensin-aldosterone system among various racial groups. This observational study is hypothesis generating and suggests that treatment of patients with heart failure and hyponatremia should perhaps be focused more on renin-angiotensin-aldosterone system reduction in certain racial groups, yet less in others.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31216316</pmid><doi>10.1371/journal.pone.0218504</doi><tpages>e0218504</tpages><orcidid>https://orcid.org/0000-0002-8078-1753</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_2243462878 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | African Americans African Americans - genetics Aged Aldosterone Analysis Angiotensin Angiotensins Atrial Fibrillation - genetics Atrial Fibrillation - mortality Atrial Fibrillation - physiopathology Blood pressure Cardiac arrhythmia Cardiac patients Cardiology Cardiovascular disease Comorbidity Congestive heart failure Demographics Demography Enzymes Ethnicity European Continental Ancestry Group - genetics Female Glucocorticoids Heart Heart attacks Heart failure Heart Failure - genetics Heart Failure - mortality Heart Failure - physiopathology Hispanic Americans Hispanic Americans - genetics Hispanic people Hospitalization Hospitals Humans Hyponatremia Hyponatremia - genetics Hyponatremia - mortality Hyponatremia - physiopathology Kidney diseases Medical prognosis Medical research Medical schools Medicine Medicine and Health Sciences Middle Aged Minority & ethnic groups Mortality Myocardial Infarction - genetics Myocardial Infarction - mortality Myocardial Infarction - physiopathology Patients People and Places Peripheral Vascular Diseases - genetics Peripheral Vascular Diseases - mortality Peripheral Vascular Diseases - physiopathology Prognosis Race Racial differences Racism Renin Retrospective Studies Risk Risk Factors Sodium Statistical analysis Steroids (Organic compounds) Studies Survival analysis Systematic review White people |
| title | Racial differences and mortality risk in patients with heart failure and hyponatremia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T15%3A19%3A32IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Racial%20differences%20and%20mortality%20risk%20in%20patients%20with%20heart%20failure%20and%20hyponatremia&rft.jtitle=PloS%20one&rft.au=Miles,%20Jeremy%20A&rft.date=2019-06-19&rft.volume=14&rft.issue=6&rft.spage=e0218504&rft.epage=e0218504&rft.pages=e0218504-e0218504&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0218504&rft_dat=%3Cgale_plos_%3EA589744664%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2243462878&rft_id=info:pmid/31216316&rft_galeid=A589744664&rft_doaj_id=oai_doaj_org_article_0080184a3f714974aaf583c1674b64a8&rfr_iscdi=true |