Race & Heart Failure Treatment

Should my race or ethnicity affect how I am treated for heart failure?

Everyone should receive the same therapies for heart failure regardless of their race or ethnicity. There is no evidence that the standard treatment for heart failure should be significantly changed because of a patient's race or ethnicity.² However, some minority groups that are predisposed to certain heart failure risk factors may be treated more aggressively or may need adjustments made to the standard treatment. African Americans, for example, who often don't respond as well as whites to ACE inhibitors, are still treated with ACE inhibitors as part of their standard heart failure treatment, but may also need additional treatment with hydralazine and isosorbide dinitrate to reduce the strain on the heart and diuretics to help control high blood pressure.^{2, 19}

Minority groups in general often have to wait longer for medical treatment and tend to receive poorer care. They are also less likely to receive counseling after leaving the hospital on how to take their medications and get their risk factors (for example, high blood pressure) under control. This may be due to bias, cultural differences, or poor access to care. These racial disparities in medical care may contribute to the worse outcomes and more frequent hospital visits experienced by minority patients with heart failure.^{20, 21} However, when heart failure patients have equal access to care and adequate follow-up, many of the health disparities disappear.^{10, 20}

If you have been diagnosed with heart failure, make sure you get clear treatment plan instructions from your health care provider, and be sure to follow them.

What is race-based medicine?

Race-based medicine is treatment aimed specifically at one racial or ethnic group. The idea for race-based medicine comes from the observation that some medications may not work the same way in all racial or ethnic groups. These differences may be due to genetic factors that affect both how the medications are processed in the body and the nature of a person's heart disease.²²

The heart failure medication BiDil (a fixed dose of hydralazine/isosorbide dinitrate) recently became the first medication specifically designated by the FDA for use in a single racial or ethnic group (African Americans). Research involving only African-American patients showed that adding it to standard heart failure treatment reduced the chance of death in by 43% and hospitalization by about 40%. The beneficial effects were seen in both women and men.^{23, 24}

See Also:

How do doctors classify racial or ethnic groups?
Should I tell my doctor about my racial or ethnic background?
Race & Heart Disease Risk

References

1. McCullough PA, Philbin EF, Spertus JA, Kaatz S, Sandberg KR, Weaver WD. Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol. January 2, 2002;39(1):60-69.
2. 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. September 20, 2005;46(6):e1-82.
3. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. Jan 29 2008;117(4):e25-146.
4. Heart Failure Society Of, America. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. Feb 2006;12(1):10-38.
5. Bahrami H, Kronmal R, Bluemke DA, et al. Differences in the Incidence of Congestive Heart Failure by Ethnicity: The Multi-Ethnic Study of Atherosclerosis. Arch Intern Med. October 27, 2008;168(19):2138-2145.
6. Dunlap SH, Sueta CA, Tomasko L, Adams KF, Jr. Association of body mass, gender and race with heart failure primarily due to hypertension. J Am Coll Cardiol. Nov 1 1999;34(5):1602-1608.
7. 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. Oct 1993;22(4 Suppl A):14A-19A.
8. Yancy C. Heart Failure in African Americans. Am J Cardiol. 2005;96(7):3-12.
9. Loehr L, Rosamond W, Chang P, Folsom A, Chambless L. Heart Failure Incidence and Survival (from the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2008;101(7):1016-1022.
10. Schocken DD, Benjamin EJ, Fonarow GC, et al. Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation. May 13, 2008;117(19):2544-2565.
11. Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. December 1, 2003;42(6):1206-1252.
12. Drazner MH, Dries DL, Peshock RM, et al. Left Ventricular Hypertrophy Is More Prevalent in Blacks Than Whites in the General Population: The Dallas Heart Study. Hypertension. July 1, 2005;46(1):124-129.
13. Kizer JR, Arnett DK, Bella JN, et al. Differences in Left Ventricular Structure Between Black and White Hypertensive Adults: The Hypertension Genetic Epidemiology Network Study. Hypertension. June 1, 2004;43(6):1182-1188.
14. Centers for Disease Control and Prevention: Diabetes & Women's Health Across the Life Stages--A Public Health Perspective: U.S. Department of Health and Human Services; October 2001.
15. Stromberg A, Martensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nurs. Apr 2003;2(1):7-18.
16. Bursi F, Weston SA, Redfield MM, et al. Systolic and Diastolic Heart Failure in the Community. JAMA. November 8, 2006;296(18):2209-2216.
17. Ilksoy N, Hoffman M, Moore RH, Easley K, Jacobson T. Comparison of African-American Patients With Systolic Heart Failure Versus Preserved Ejection Fraction. Am J Cardiol. Sept 15 2006;98(6):806-808.
18. Devereux RB, Roman MJ, Liu JE, et al. Congestive heart failure despite normal left ventricular systolic function in a population-based sample: the Strong Heart Study. Am J Cardiol. 2000;86(10):1090-1096.
19. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA. May 21, 2003;289(19):2560-2571.
20. Yancy CW, Abraham WT, Albert NM, et al. Quality of Care of and Outcomes for African Americans Hospitalized With Heart Failure: Findings From the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) Registry. J Am Coll Cardiol. April 29, 2008;51(17):1675-1684.
21. Mehta SK, Toto KH, Nelson LL, Drazner MH. Therapy of heart failure in African Americans: lessons from an urban public hospital. Congest Heart Fail. Jan-Feb 2004;10(1):40-43.
22. Wilkinson GR. Drug Metabolism and Variability among Patients in Drug Response. N Engl J Med. May 26, 2005;352(21):2211-2221.
23. Taylor AL, Ziesche S, Yancy C, et al. Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure. N Engl J Med. November 11, 2004;351(20):2049-2057.
24. Taylor AL, Lindenfeld J, Ziesche S, et al. Outcomes by Gender in the African-American Heart Failure Trial. J Am Coll Cardiol. December 5, 2006;48(11):2263-2267.