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

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.

Impact of Race on Clinical Outcomes After Implantation With a Fully Magnetically Levitated Left Ventricular Assist Device: An Analysis From the MOMENTUM 3 Trial

“…28,30,31 A multitude of causes have been implicated in this outcome disparity including biological/genetic, societal (access to healthy lifestyle choices), and healthcare (insurance and guideline-directed medical treatment access) factors. 34 While no difference was detected between Black and White HM3 recipients with regards to the primary end point, the present study identified independent predictors of Black LVAD patient outcomes. Age >65 years was identified as an independent predictor of primary end point failure while better baseline renal function (estimated by estimated glomerular filtration rate) was demonstrated to predict primary end point success in our analysis.…”

Sodium-Glucose Cotransporter-2 Inhibitor Use is Associated with a Reduced Risk of Heart Failure Hospitalization in Patients with Heart Failure with Preserved Ejection Fraction and Type 2 Diabetes Mellitus: A Real-World Study on a Diverse Urban Population

“…Our patient population is truly diverse and mainly consisted of racial and ethnic minorities, with Black and Hispanic participants forming a majority—groups who can be under-represented in randomized multicenter studies. In addition, studies have shown that Black patients have a significantly higher rate of HFH [ 45 ]. Representation of this population in our study is therefore relevant and complements the results of randomized controlled trials.…”

Food insecurity and cardiovascular disease: Current trends and future directions

“…FI may pose a higher cardiovascular risk for racial and ethnic minorities, relative to their NHW counterparts, due to the generally higher rates of clinical risk factors such as diabetes, hypertension, and obesity, all of which contribute to worse cardiovascular outcomes [ 63 ]. Structural barriers, such as socioeconomic inequality, educational disparities, and bias and discrimination in healthcare, as well as historical practices like redlining – which subjects Black and other under-represented racial/ethnic populations to discrimination in housing – have been reported to contribute to the disproportionately higher rates of cardiovascular risk factors and CVD among racial/ethnic minorities, compared to NHW individuals [ 64 , 65 ].…”