Current Cardiovascular Risk Reports

, Volume 2, Issue 3, pp 198–202 | Cite as

Heart failure in African Americans: Earlier onset, different etiologies, and poorer prognosis



Heart failure (HF) is more prevalent in African Americans than in Caucasians, with an earlier age of onset and higher likelihood of nonischemic etiology and prior hypertension. Most studies show increased rates of hospitalizations in African Americans with HF, with similar overall survival. Clinical trials provide evidence of benefits with standard HF medical therapy in this population, including angiotensin-converting enzyme inhibitors and β-blockers. African Americans with HF derive substantial survival benefits with the fixed-dose combination of isosorbide dinitrate and hydralazine when added to other standard therapies. African American patients with HF receive similar quality of care in terms of certain HF medications but are less likely to receive HF education and counseling or implantable cardioverter defibrillators.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    American Heart Association: Heart Disease and Stroke Statistics. Dallas: American Heart Association; 2005. Available at Accessed March 6, 2008.Google Scholar
  2. 2.
    Yancy CW: Heart failure in African Americans. Am J Cardiol 2005, 96:3i–12i.PubMedCrossRefGoogle Scholar
  3. 3.
    Heart Failure Society of America: Management of heart failure in special populations. J Card Fail 2006, 12:e115–e119.PubMedCrossRefGoogle Scholar
  4. 4.
    Echols MR, Felker GM, Thomas KL, et al.: Racial differences in the characteristics of patients admitted for acute decompensated heart failure and their relation to outcomes: results from the OPTIME-CHF Trial. J Card Fail 2006, 12:684–688.PubMedCrossRefGoogle Scholar
  5. 5.
    Bourassa MG, Gurne O, Bangdiwala SI, et al.: Natural history and patterns of current practice in heart failure. The Studies of Left Ventricular Dysfunction (SOLVD) Investigators. J Am Coll Cardiol 1993, 22(4 Suppl A):14A–19A.PubMedCrossRefGoogle Scholar
  6. 6.
    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, 5:178–187.PubMedCrossRefGoogle Scholar
  7. 7.
    Dries DL, Exner DV, Gersh BJ, et al.: Racial differences in the outcome of left ventricular dysfunction. N Engl J Med 1999, 340:609–616.PubMedCrossRefGoogle Scholar
  8. 8.
    Deswal A, Petersen NJ, Souchek J, et al.: Impact of race on health care utilization and outcomes in veterans with congestive heart failure. J Am Coll Cardiol 2004, 43:778–784.PubMedCrossRefGoogle Scholar
  9. 9.
    Alexander M, Grumbach K, Remy L, et al.: Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity. Am Heart J 1999, 137:919–927.PubMedCrossRefGoogle Scholar
  10. 10.
    Rathore SS, Foody JM, Wang Y, et al.: Race, quality of care, and outcomes of elderly patients hospitalized with heart failure. JAMA 2003, 289:2517–2524.PubMedCrossRefGoogle Scholar
  11. 11.
    Small KM, Wagoner LE, Levin AM, et al.: Synergistic polymorphisms of beta1-and alpha2C-adrenergic receptors and the risk of congestive heart failure. N Engl J Med 2002, 347:1135–1142.PubMedCrossRefGoogle Scholar
  12. 12.
    McNamara DM, Tam SW, Sabolinski ML, et al.: Aldosterone synthase promoter polymorphism predicts outcome in African Americans with heart failure: results from the A-HeFT trial. J Am Coll Cardiol 2006, 48:1277–1282.PubMedCrossRefGoogle Scholar
  13. 13.
    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, 344:1351–1357.PubMedCrossRefGoogle Scholar
  14. 14.
    Shekelle PG, Rich MW, Morton SC, 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, 41:1529–1538.PubMedCrossRefGoogle Scholar
  15. 15.
    Hunt SA: ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005, 46:e1–e82.PubMedCrossRefGoogle Scholar
  16. 16.
    Yancy CW, Fowler MB, Colucci WS, et al.: Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. N Engl J Med 2001, 344:1358–1365.PubMedCrossRefGoogle Scholar
  17. 17.
    Goldstein S, Deedwania P, Gottlieb S, Wikstrand J: Metoprolol CR/XL in black patients with heart failure (from the Metoprolol CR/XL randomized intervention trial in chronic heart failure). Am J Cardiol 2003, 92:478–480.PubMedCrossRefGoogle Scholar
  18. 18.
    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, 344:1659–1667.CrossRefGoogle Scholar
  19. 19.
    Goldstein S: Beta blocker therapy in African American patients with heart failure. Heart Fail Rev 2004, 9:161–167.PubMedCrossRefGoogle Scholar
  20. 20.
    Cohn JN, Johnson G, Ziesche S, et al.: A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991, 325:303–310.PubMedGoogle Scholar
  21. 21.
    Taylor AL, Ziesche S, Yancy C, et al.: Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med 2004, 351:2049–2057.PubMedCrossRefGoogle Scholar
  22. 22.
    Taylor AL, Ziesche S, Yancy CW, et al.: Early and sustained benefit on event-free survival and heart failure hospitalization from fixed-dose combination of isosorbide dinitrate/hydralazine: consistency across subgroups in the African-American Heart Failure Trial. Circulation 2007, 115:1747–1753.PubMedCrossRefGoogle Scholar
  23. 23.
    Cohn JN, Tam SW, Anand IS, et al.: Isosorbide dinitrate and hydralazine in a fixed-dose combination produces further regression of left ventricular remodeling in a well-treated black population with heart failure: results from A-HeFT. J Card Fail 2007, 13:331–339.PubMedCrossRefGoogle Scholar
  24. 24.
    Deswal A, Petersen NJ, Urbauer DL, et al.: Racial variations in quality of care and outcomes in an ambulatory heart failure cohort. Am Heart J 2006, 152:348–354.PubMedCrossRefGoogle Scholar
  25. 25.
    Yancy CW, Abraham WT, Albert NM, et al.: Defining the natural history and improving quality of care for African Americans hospitalized with heart failure: a report from the organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF). Circulation 2005, 112:II–506.Google Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.UCLA Medical CenterLos AngelesUSA

Personalised recommendations