“These findings are impressive and suggest that efforts to prevent
heart failure and improve the outpatient treatment of heart failure
have had overall success in reducing the number of heart failure
patients needing hospitalizations,” senior study author Dr. Gregg C.
Fonarow from David Geffen School of Medicine at University of
California, Los Angeles told Reuters Health. “However, the
improvements were not equally distributed across race/ethnicities
and genders, and additional efforts are needed.”
Fonarow’s team used information from a national registry of U.S.
hospitalizations to investigate trends in heart failure hospital
admissions in the decade between 2002 and 2013, when there were a
total of more than 12 million hospitalizations for heart failure.
When adjusted for age, heart failure hospitalization rates fell by
30.8 percent, an average of 3.3 percent per year, during this
period. Overall, rates dropped faster for women, falling 36.0
percent, than for men, for whom they fell 25.8 percent.
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Hospitalization rates decreased at about the same rate for whites
(29.6 percent) and for blacks (29.4 percent), but throughout this
time, rates were more than twice as high among black men and women,
according to the report in Circulation: Cardiovascular Quality and
Outcomes.
Hispanics experienced a greater decrease in heart failure
hospitalization rates, which dropped by 48.4 percent, narrowing
their rates relative to whites to within a few percentage points.
Similarly, heart failure hospitalization rates dropped dramatically,
by 47.5 percent, among Asians and Pacific Islanders. By 2013, they
were 43 percent lower than those for whites.
“Heart failure is largely preventable, and the disparities
identified can be reduced or eliminated,” Fonarow said. “The
findings highlight the urgent need to address population-based
health and prevention, with specific targeting of those most at
risk. Equitable health is achievable but will take multidimensional
national, community, and local efforts,” he told Reuters Health by
email.
“In particular, high blood pressure is a major risk factor for
developing heart failure, and achieving optimal blood pressure
levels can reduce the risk by more than half. Better awareness,
treatment, and control of blood pressure, particularly for black men
and women is critical,” Fonarow said.
“The time to intensify equitable efforts to prevent and optimize the
treatment of heart failure is now,” he said.
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"That blacks have a 2.5x higher hospitalization rate for heart
failure compared to whites is an important finding,” Dr. Parag Goyal
from Weill Cornell Medical College in New York, who wasn’t involved
in the study, said by email. “As the authors point out, the degree
of this disparity (specifically in heart failure) has largely been
under-appreciated to date, as prior studies have failed to adjust
for the younger age distribution of blacks compared to whites.”
Goyal said he hopes the study will stimulate further exploration of
the reasons underlying these differences.
“These race-related disparities likely go beyond a genetic or
physiologic basis; consequently, there is a need to develop
population-based interventions to reduce the significant burden of
hospitalizations faced by blacks with heart failure,” Goyal said.
“Future research should focus on examining the unique
vulnerabilities of blacks with heart failure that may underlie this
finding.”
Dr. Jia-Rong Wu from The University of North Carolina at Chapel Hill
School of Nursing has explored health disparities in patients with
heart failure based on ethnicity and financial status and agrees
that money and higher rates of other health conditions are important
factors.
“However,” she said by email, “in addition to socioeconomic and
clinical factors, we found some behavioral factors were associated
with cardiac/heart failure hospitalizations. Therefore, it is
important to optimize heart failure management and control/manage
risk factors (smoking, hypertension, diabetes, and hyperlipidemia),”
Wu said.
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“It is equally important to develop interventions/strategies to help
black patients with heart failure to improve self-care behaviors to
eliminate the disparities.”
SOURCE: http://bit.ly/2tlAAUu Circulation: Cardiovascular Quality
and Outcomes, online June 27, 2017.
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