Health Disparities in Heart Failure

Heart disease is the number one cause of death in the United States (US).¹ Heart failure (HF) is a type of heart disease that affects about 5.7 million people in the US.² HF is more common in older people, especially people over 65 years old. HF leads to more hospital stays than any other disease in the US and costs 30 billion dollars annually for treatment and loss of work.²

Disparities in HF in African Americans

African Americans are more likely to have HF than whites.³ African Americans are more likely to have HF at a younger age than whites. When African Americans are hospitalized for HF they are 45 percent more likely to die or have worse outcomes than whites.³

There is no single reason that African Americans have worse HF outcomes than whites. African Americans may have other risk factors for HF. Diseases like diabetes, high blood pressure, and obesity are common in African Americans.³ These diseases are all risk factors that contribute to HF.

African Americans with HF often have lower incomes.³ They often have no insurance at all which may lead to a delay in care or lack of care. Doctors may not diagnose HF in younger African American patients because they may not have common HF symptoms.³

Disparities in HF care for African Americans

There are differences in how doctors treat HF in African Americans. Doctors are less likely to prescribe certain medications to African American patients than they are to white patients.³ These medications include groups of medications known as ACE inhibitors, diuretic medications and a drug called Digoxin.

There are surgical treatments available for HF. These treatments include devices such as cardiac resynchronization therapy defibrillators (CRT-D) and left ventricular assist devices (LVAD).³ A CRT-D is a device similar to a pacemaker. An LVAD is a mechanical device that is implanted into the heart that helps the heart to pump blood.

African American patients are less likely to be treated with either a CRT-D or an LVAD than a white patient.³ Hispanic patients are also less likely to get a CRT-D than white patients. This may be because doctors believe that African American and Hispanic patients are less likely to return for follow-up care.³ Doctors may also believe that African American and Hispanic patients are more uneducated and more likely to refuse treatment.

Disparities in HF in women

There are also disparities in HF in women. The risk of developing heart failure is 20 percent for both men and women.³ The risk changes for women over the age of 40 who have not had a prior heart attack. The risk for women lowers to 17 percent of women (1 in 6), but the risk for men lowers to 11 percent (1 in 9). Women are also more likely to develop HF later in life (over 80 years old) than men.³ Women are also more likely to have other symptoms that are not controlled which can lead to HF. These include diabetes and high blood pressure.

Men are 2.5 times more likely to receive an LVAD for HF than women.³ Men are twice as likely to receive an implantable cardioverter-defibrillator (ICD) than women. This might be because women are diagnosed with HF at a later age than men.³

Are these disparities changing?

Doctors recognize that there is a problem with health disparities in HF. They are trying to change these disparities. There are more African American and Hispanic patients receiving ICDs than ever before.³ Doctors are also trying to start programs that prevent HF before it has to be treated. These programs target people who would have the worst outcomes in HF care.² These programs are aimed at losing weight, quitting smoking, and starting exercise programs.² While there is no way to completely end all health disparities overnight, doctors are actively trying to close the gaps.

Talk to your health care team if you have concerns about your heart health. They can discuss options for heart disease prevention and treatment that best meet your needs.