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Review
. 2020 Aug;13(8):e007264.
doi: 10.1161/CIRCHEARTFAILURE.120.007264. Epub 2020 Aug 13.

Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients

Aditi Nayak  1 , Albert J Hicks  2 , Alanna A Morris  1
Affiliations
Review

Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients

Aditi Nayak et al. Circ Heart Fail. 2020 Aug.

Abstract

Although care of patients with heart failure (HF) has improved in the past decade, important disparities in HF outcomes persist based on race/ethnicity. Age-adjusted HF-related cardiovascular disease death rates are higher for Black patients, particularly among young Black men and women whose rates of death are 2.6- and 2.97-fold higher, respectively, than White men and women. Similarly, the rate of HF hospitalization for Black men and women is nearly 2.5-fold higher when compared with Whites, with costs that are significantly higher in the first year after HF hospitalization. While the relative rate of HF hospitalization has improved for other race/ethnic minorities, the disparity in HF hospitalization between Black and White patients has not decreased during the last decade. Although access to care and socioeconomic status have been traditional explanations for the observed racial disparities in HF outcomes, contemporary data suggest that novel factors including genetic susceptibility as well as social determinants of health and implicit bias may play a larger role in health outcomes than previously appreciated. The purpose of this review is to describe the complex interplay of factors that influence racial disparities in HF incidence, prevalence, and disease severity, with a highlight on evolving knowledge that will impact the clinical care and address future research needs to improve HF disparities in Blacks.

Keywords: cardiovascular disease; ethnic groups; heart failure; incidence; prevalence.

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Conflict of interest statement

DISCLOSURES

The authors have no relevant conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Age-Adjusted HF-Related CVD Mortality Rates in the US, 1999 to 2017. Death rates per 100,000 by sex and race, note the difference in scale for the Y-axis by age group. Reprinted with permission from Glynn et al.
Figure 2.
Figure 2.
National age-standardized hospitalization rate by race/ethnicity and sex from the National Inpatient Sample. PI indicates Pacific Islander. Reprinted with permission from Ziaeian et al.
Figure 2.
Figure 2.
National age-standardized hospitalization rate by race/ethnicity and sex from the National Inpatient Sample. PI indicates Pacific Islander. Reprinted with permission from Ziaeian et al.
Figure 3.
Figure 3.
Multiple levels of influence on racial disparities in HF incidence and clinical outcomes once clinical disease is manifest.
Figure 4.
Figure 4.
Targets for improving racial HF disparities utilizing the framework of the social-ecological model.
See this image and copyright information in PMC

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