Impact of race on morbidity and mortality in patients with congestive heart failure: A study of the multiracial population in Singapore

Aim We assessed the impact of race on clinical outcome in the multiracial Singapore congestive heart failure (CHF) population. Methods 668 CHF patients (Age 66±12 years, Ejection fraction 29±13%), consisting of Chinese (72%), Malays (17.1%) and Indians (10.9%) were prospectively followed up for 24±12 months. Primary outcome measure was the composite end-point of all-cause mortality or CHF readmission. Results Composite end-points occurred in 198 (29.6%) patients (133 deaths, 112 CHF readmissions). Diabetes mellitus (DM), peripheral vascular disease and hyperlipidemia were more prevalent in Indians compared to Malays or Chinese (all p<0.05). Indians and Malays had higher composite end-point rates compared to the Chinese (p=0.01). Although Indians and Malays had higher CHF readmission rates compared to the Chinese (p<0.01), a trend towards a higher all-cause mortality rate was seen in Malays (p=0.12). Malay race was an independent predictor of the composite end-point (OR=1.65, 95% CI=1.04–2.63, p=0.034), as were age, diabetes mellitus, ischemic cardiomyopathy, beta-blocker use, and NYHA class (all p<0.05). Conclusions In the multiracial Singapore CHF population, Indians and Malays had a worse outcome compared to the Chinese, due to higher CHF readmission rates in Indians and higher mortality and CHF readmission rates in Malays. While the worse outcome in Indians may be due to the greater prevalence of diabetes mellitus and atherosclerotic vascular disease, the cause of the poorer prognosis in Malays is unclear.