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Fewer admissions for heart failure, but blacks still fare worse than whites

[June 28, 2017] By Will Boggs MD

(Reuters Health) - Between 2002 and 2013, hospital admissions for heart failure fell by nearly a third in the U.S., but blacks are still more than twice as likely as whites to be hospitalized for the condition, researchers say.

“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.

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.

“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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