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Racial Disparities Persist for Patients With Ambulatory Heart Failure


Recent results show a consistent overall prevalence of ambulatory heart failure, but that Blacks still have a greater prevalence of the condition.

Results from data analysis of participants in the National Health and Nutrition Examination Survey (NHANES) show that although the overall prevalence of ambulatory heart failure remained consistent over a 15-year period, Blacks compared with Whites still have a greater prevalence of the condition when looking at the variable of race.

These disparities persisted for individuals who were younger or middle-aged, reports the study in JAMA Cardiology.

“Recent national trends in the prevalence of heart failure need to be clarified to appropriately allocate resources and develop effective preventive interventions,” they noted.

NHANES provided the data for this cross-sectional study that were collected every 2 years on 26,097 participants from January 1, 2001, through December 31, 2016. All nonpregnant adults aged 35 and older were included in the analysis, and the authors divided their self-reports on ambulatory heart failure, race/ethnicity, and age (35-64 and >65 years) into 4 periods: 2001-2004, 2005-2008, 2009-2012, and 2013-2016. The age cut-off of 35 was chosen so that instances of congenital heart disease would not influence the results.

The mean (SD) patient age was 55.9 (10.7) years, and 52% (n = 13.192) of respondents were female, 12% (n = 6519) were non-Hispanic Black, and 7% (n = 4906) were Mexican American.

Per 100,000 population, the study findings show that ambulatory heart failure had an overall age-standardized prevalence of 3184 (95% CI, 2641-3728) in 2001-2005 and 3045 (95% CI, 2651-3438) in 2013-2016. This slight 4.3% improvement was deemed by the authors as a stable rate of occurrence between the periods, “indicating no improvements in the high burden of heart failure in the United States,” they noted.

However, non-Hispanic Blacks still had the highest rate, which occurred in the 2013-2016 period. During this time, there were 5017 (95% CI, 3755-6279) instances of ambulatory heart failure in the patient group. Mexican American adults had the lowest prevalence, at 2508 (95% CI, 1154-3862), and non-Hispanic White adults fell in-between, at 2746 (95% CI, 2313-3179).

As alluded to above, age was also a factor in ambulatory heart failure prevalence. Younger and middle-aged (35-64 years old) Black adults had a prevalence of the disease that was almost 3 times that among similar-aged Whites for the 2013-2016 period: 3864 (95% CI, 2369-5359) among non-Hispanic Blacks compared with 1297 (95% CI, 878-1716) among non-Hispanic White adults. Both rates were per 100,000 individuals.

Stratification by sex did not produce meaningful differences. Logistic regression aided in the trend analysis. Data were analyzed between November 16, 2019, and April 12, 2020.

Analyses produced these additional results per 100,000 population:

  • The most common risk factors for heart failure among non-Hispanic Black adults were obesity (43%), hypertension (36%), and diabetes (17%), all of which increased from the first study period (34%, 28%, and 11%, respectively) to the last
  • The rate of heart failure for non-Hispanic Black adults was higher in the last vs the first study period: 5017 (previously mentioned) vs 3733 (95% CI, 2556-4910)
  • For Mexican American adults aged 35 to 64 years, the prevalence of heart failure was 2046 (95% CI, 518-3576) for the 2013-2016 period
  • For adults 65 years and older in 2013-2016, Mexican American adults had the lowest prevalence of heart failure: 6022 (95% CI, 3971-8072) vs 8006 (95% CI, 6572-9439) for non-Hispanic White adults and 11,038 (95% CI, 7491-14,584) for non-Hispanic Black adults

The authors attribute the ongoing disparity “to the disproportionate prevalence and earlier onset of heart failure risk factors, such as obesity, diabetes, and hypertension, among Black men and women,” while noting that greater overall rates of obesity and diabetes could indicate overall changes in prevalence. They took up their survey to examine these rates.

“The higher rates of heart failure among younger non-Hispanic Black adults may be associated with a number of factors, including disparities in prevalence and control of risk factors as well as upstream socioeconomic factors,” the authors concluded. “These factors are of particular concern given the morbidity associated with the diagnosis of heart failure and the unique financial and social consequences of an early diagnosis.”

Public policies and programs need to make greater investments in and aggressively target heart failure prevention to close the racial disparity gap that seems to be growing for this condition, they noted.


Rethy L, Petito LC, Vu THT, et al. Trends in the prevalence of self-reported heart failure by race/ethnicity and age from 2001 to 2016. JAMA Cardiol. Published online September 2, 2020. doi:10.1001/jamacardio.2020.3654

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