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Racial and Ethnic Differences in Heart Failure Etiology, Prognosis, and Management

  • Race + Ethnicity Disparities (K Watson, Section Editor)
  • Published:
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Abstract

Heart failure (HF) remains a major health care burden for the USA. Racial/ethnic groups in the USA are at increased risk for developing HF and incur higher rates of morbidity. Understanding the variations in the clinical syndrome of HF among different racial/ethnic groups is fundamental to addressing how to effectively treat these sub-groups. Despite evidence-based guideline-recommended medical and device therapy for HF, eligible patients from various racial/ethnic groups suffer disparities in receiving guideline-based HF therapy. The initiation of performance improvement programs has improved adherence to guideline-based therapy. The racial/ethnic differences that exist regarding the etiology and responses to medical therapy are fundamental to addressing ways to improve access to care, adherence, and overall survival in these at-risk groups. The review outlines racial/ethnic variations in the etiology, prognosis, and management with medical and device therapy for HF.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulatory. 2014;129:e28–292.

    Article  Google Scholar 

  2. Bahrami H, Kronmal R, Bluemke DA, Olson J, Shea S, Liu K, et al. Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis. Arch Intern Med. 2008;168(19):2138–45.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Grieco EM and Cassidy RC. Overview of race and Hispanic origin. US Census Bureau. Issued March 2001. Available at http://www.census.gov/prod/2001pubs/c2kbr01-1.pdf. Accessed August 4, 2014.

  4. Thomas KL, Hernandez AF, Dai D, Heidenreich P, Fonarow GC, Peterson ED, et al. Association of race/ethnicity with clinical risk factors, quality of care, and acute outcomes in patients hospitalized with heart failure. Am Heart J. 2011;161(4):746–54. Retrospective analysis illustrating HF risk factors and in-hospital mortality rates for African American and Hispanic patients admitted with HF.

    Article  PubMed  Google Scholar 

  5. Yancy CW. Heart failure in African Americans: pathophysiology and treatment. J Card Fail. 2003;9(5 Suppl Nitric Oxide):S210–5.

    Article  CAS  PubMed  Google Scholar 

  6. Bibbins-Domingo K, Pletcher MJ, Lin F, Vittinghoff E, Gardin JM, Arynchyn A, et al. Racial differences in incident heart failure among young adults. N Engl J Med. 2009;360(12):1179–90. Evaluates the incidence of HF over a 20-year period among whites and African Americans revealing important predispositions to HF in African American race.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Vivo RP, Krim SR, Cevik C, Witteles RM. Heart failure in Hispanics. J Am Coll Cardiol. 2009;53(14):1167–75. State of the art review of HF in Hispanics.

    Article  PubMed  Google Scholar 

  8. Becker TM, Wiggins CL, Key CR, Samet JM. Ethnic differences in mortality from acute rheumatic fever and chronic rheumatic heart disease in New Mexico, 1958–1982. West J Med. 1989;150:46–50.

    CAS  PubMed Central  PubMed  Google Scholar 

  9. Leiby DA, Rentas FJ, Nelson KE, Stambolis VA, Ness PM, Parnis C, et al. Evidence of Trypanosoma cruzi infection (Chagas' disease) among patients undergoing cardiac surgery. Circulation. 2000;102:2978–82.

    Article  CAS  PubMed  Google Scholar 

  10. Choi D, Nemi E, Fernando C, Gupta M, Moe GW. Differences in the clinical characteristics of ethnic minority groups with heart failure managed in specialized heart failure clinics. JACC Heart Fail. 2014;2(4):392–9. Recent retrospective analysis from two specialty HF clinics highlighting clinical characteristics of Chinese and South Asians patients with HF.

    Article  PubMed  Google Scholar 

  11. Sanderson JE, Ts TF. Heart failure: a global disease requiring a global response. Heart. 2003;89:585–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Blackledge HM, Newton J, Squire IB. Prognosis for South Asian and white patients newly admitted to hospital with heart failure in the United Kingdom: historical cohort study. BMJ. 2003;327(7414):526–31.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey Jr DE, Drazner MH, et al. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147–239. ACC/AHA HF guidelines outline an algorithm for identifying patients at different stages of HF, diagnostic strategies, and oral and device therapy for management.

    Article  PubMed  Google Scholar 

  14. Brown DW, Haldeman GA, Croft JB, Giles WH, Mensah GA. Racial or ethnic differences in hospitalization for heart failure among elderly adults: Medicare, 1990 to 2000. Am Heart J. 2005;150(3):448–54.

    Article  PubMed  Google Scholar 

  15. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Rodriguez F, Joynt KE, López L, Saldaña F, Jha AK. Readmission rates for Hispanic Medicare beneficiaries with heart failure and acute myocardial infarction. Am Heart J. 2011;162(2):254–261.e3. Demonstrates higher rates of readmissions amongst elderly Hispanics with HF.

    Article  PubMed  Google Scholar 

  17. Kamath SA, Drazner MH, Wynne J, Fonarow GC, Yancy CW. Characteristics and outcomes in African American patients with decompensated heart failure. Arch Intern Med. 2008;168(11):1152–8.

    Article  PubMed  Google Scholar 

  18. Adams KF, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100 000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149(2):209–16.

    Article  PubMed  Google Scholar 

  19. Vivo RP, Krim SR,Liang L, Neely M, Hernandez AF, Eapen ZJ, Peterson ED, Bhatt DL, Heidenreich PA, Yancy CW, Fonarow GC. Short- and long-term hospitalization and mortality for heart failure in four racial/ethnic populations. J Am Heart Assoc. 2014;In press. Highlights variations in mortality and short- and long-term readmissions amongst 4 different racial/ethnic groups admitted with HF.

  20. Krim SR, Vivo RP, Krim NR, Qian F, Cox M, Ventura H, et al. Racial/Ethnic differences in B-type natriuretic peptide levels and their association with care and outcomes among patients hospitalized with heart failure: findings from Get With The Guidelines-Heart Failure. JACC Heart Fail. 2013;1(4):345–52. Retrospective analysis revealing race-related differences in the prognostic value of BNP levels for HF admissions.

    Article  PubMed  Google Scholar 

  21. The SOLVD. Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325(5):293–302.

    Article  Google Scholar 

  22. Carson P, Ziesche S, Johnson G, Cohn JN. Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials: Vasodilator-Heart Failure Trial Study Group. J Card Fail. 1999;5:178–87.

    Article  CAS  PubMed  Google Scholar 

  23. Exner DV, Dries DL, Domanski MJ, Cohn JN. Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med. 2001;344(18):1351–7.

    Article  CAS  PubMed  Google Scholar 

  24. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327:685–91.

    Article  Google Scholar 

  25. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.

    Article  Google Scholar 

  26. Preston RA, Materson RA, Reda DJ, et al. Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. JAMA. 1998;280:1168–72.

    Article  CAS  PubMed  Google Scholar 

  27. Case DB, Wallace JM, Kein HJ, Weber MA, Sealey JE, Laragh JH. Possible role of renin in hypertension as suggested by renin-sodium profiling and inhibition of converting enzymes. N Engl J Med. 1977;296:641–6.

    Article  CAS  PubMed  Google Scholar 

  28. Cody RJ, Laragh JH, Case DB, Atlas SA. Renin system activity as a determinant of response treatment in hypertension and heart failure. Hypertension. 1983;5(Suppl III):III-36–42.

    CAS  Google Scholar 

  29. Campia U, Choucair WK, Bryant MB, Waclawiw MA, Cardillo C, Panza JA. Reduced endothelium-dependent and -independent dilation of conductance arteries in African Americans. J Am Coll Cardiol. 2002;40(4):754–60.

    Article  CAS  PubMed  Google Scholar 

  30. Shekelle PG, Rich MW, Morton SC, Atkinson CS, Tu W, Maglione M, et al. Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials. J Am Coll Cardiol. 2003;41(9):1529–38.

    Article  CAS  PubMed  Google Scholar 

  31. Yancy CW, Fowler MB, Colucci WS, et al. Race and the response to adrenergic blockade with carvedilol in patient with chronic heart failure. N Engl J Med. 2001;344:1358–65.

    Article  CAS  PubMed  Google Scholar 

  32. Beta-Blocker Evaluation of Survival Trial Investigators. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med. 2001;344(22):1659–67.

    Article  Google Scholar 

  33. CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999;353(9146):9–13.

    Article  Google Scholar 

  34. Kelesidis I, Varughese CJ, Hourani P, Zolty R. Effects of β-adrenergic blockade on left ventricular remodeling among Hispanics and African Americans with chronic heart failure. Clin Cardiol. 2013;36(10):595–602.

    PubMed  Google Scholar 

  35. Vardeny O, Cavallari LH, Claggett B, Desai AS, Anand I, Rossignol P, et al. Race influences the safety and efficacy of spironolactone in severe heart failure. Circ Heart Fail. 2013;6(5):970–6. Highlights race-related differences between African Americans and non-African Americans with spironolactone therapy.

    Article  CAS  PubMed  Google Scholar 

  36. Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino Jr R, Ferdinand K, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. 2004;351:2049–57.

    Article  CAS  PubMed  Google Scholar 

  37. Ziaeian B, Zhang Y, Albert NM, Curtis AB, Gheorghiade M, Heywood JT, et al. Clinical effectiveness of CRT and ICD therapy in heart failure patients by racial/ethnic classification: insights from the IMPROVE HF registry. J Am Coll Cardiol. 2014;64(8):797–807. Retrospective analysis from IMPROVE HF illustrating equal clinical effectiveness of ICD/CRT-D therapy amongst different race/ethnic groups.

    Article  PubMed  Google Scholar 

  38. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med. 1999;341(25):1882–90.

    Article  CAS  PubMed  Google Scholar 

  39. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83.

    Article  PubMed  Google Scholar 

  40. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2010. Washington, DC. Available at http://www.cdc.gov/nchs/healthy_people/hp2010.htm. Accessed September 12, 2014.

  41. Al-Khatib SM, Hellkamp AS, Hernandez AF, Fonarow GC, Thomas KL, Al-Khalidi HR, et al. Trends in use of implantable cardioverter-defibrillator therapy among patients hospitalized for heart failure: have the previously observed sex and racial disparities changed over time? Circulation. 2012;125(9):1094–101. Demonstrates how enrollment in a quality improvement program improves adherence to guideline-recommended therapy in eligible patients.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Reynolds D, Albert NM, Curtis AB, Gheorghiade M, Heywood JT, Mcbride ML, et al. Race and improvements in the use of guideline-recommended therapies for patients with heart failure: findings from IMPROVE HF. J Natl Med Assoc. 2012;104(5–6):287–98. Demonstrates how enrollment in an outpatient quality improvement program narrows race-based differences in health care delivery in outpatient cardiology settings.

    PubMed  Google Scholar 

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Conflict of Interest

Gregg Fonarow worked as a consultant for Medtronic, Novartis, Johnson and Johnson, Amgen, Bayer, Boston Scientific, The Medicines Company, and Gambro. Fonarow is employed as the Eliott Corday Professor of Cardiovascular Medicine and Science; Fonarow has received grants from the NIH and AHRQ. Sheila Sahni and Tamara Horwich have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

SS and TBH, none; GCF consulting for Amgen, Bayer, Gambro, Janssen, Medtronic, Novartis.

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Authors and Affiliations

  1. Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, 10833 LeConte Ave, Room 47-123 CHS, Los Angeles, CA, 90095-1679, USA

    Sheila Sahni, Tamara B. Horwich & Gregg C. Fonarow

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  1. Sheila Sahni
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  2. Tamara B. Horwich
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  3. Gregg C. Fonarow
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Correspondence to Gregg C. Fonarow.

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This article is part of the Topical Collection on Race + Ethnicity Disparities

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Sahni, S., Horwich, T.B. & Fonarow, G.C. Racial and Ethnic Differences in Heart Failure Etiology, Prognosis, and Management. Curr Cardiovasc Risk Rep 9, 426 (2015). https://doi.org/10.1007/s12170-014-0426-1

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  • DOI: https://doi.org/10.1007/s12170-014-0426-1

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