Abstract
BACKGROUND: Ethnic disparities in heart failure (HF) outcomes have been widely documented, but data from countries with universal healthcare systems, such as Israel, are limited. This study assessed whether long-term clinical outcomes differ between Jewish and non-Jewish patients hospitalized for acute decompensated heart failure (ADHF). METHODS: We conducted a retrospective cohort study of adults hospitalized with ADHF at a tertiary medical center in Israel between 2007 and 2017. Patients were categorized by self-reported ethnicity. Baseline characteristics, in-hospital treatments, discharge medications, and clinical outcomes were compared. The primary outcome was 5-year all-cause mortality. Secondary outcomes included in-hospital mortality, 30-day readmission, 30-day mortality, 1-year mortality, and treatment patterns. RESULTS: Of 7,199 patients, 90.3% were Jewish and 9.7% non-Jewish. Non-Jewish patients were younger (median age 74 vs. 80 years, p < 0.001) and had higher rates of smoking and obesity. Most comorbidities, procedures, and discharge therapies were comparable. Unadjusted short-term outcomes were similar between groups. Although unadjusted 5-year survival appeared higher in non-Jews (p = 0.002), multivariable Cox regression showed that non-Jewish ethnicity was independently associated with increased 5-year mortality (HR 1.13, 95% CI 1.02-1.25, p = 0.021). CONCLUSIONS: In this large cohort of patients hospitalized with ADHF in Israel, non-Jewish ethnicity was independently associated with worse long-term survival despite younger age and similar in-hospital care. These findings underscore the need for targeted follow-up strategies to mitigate ethnic disparities in chronic HF outcomes.