Research published in May 2019 in the Journal of the American College of Cardiology points out that the rise has been most dramatic among African Americans. Scientists calculated that the heart failure–related death rate among Americans ages 35 to 64 in 2017 was 2.6 times greater for African American men compared with white men and about 3 times more for African American women compared with white women. “More than one-half of black adults have hypertension and high rates of obesity and diabetes, which may explain a portion of the disparities in heart failure mortality,” says study author Sadiya Khan, MD, assistant professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist in Chicago. “Beyond differences in risk factor prevalence, disparities in access to care unfortunately contribute to both inadequate prevention and diagnosis. We need to do better in terms of access to care for all Americans.” Results from this analysis were based on death-certificate data collected by the CDC on 47,728,569 individuals who died between 1999 and 2017. The overall number of U.S. adults ages 35 to 84 who died from heart failure initially declined from 79 deaths per 100,000 people in 1999 to 54 deaths per 100,000 people in 2012. After that point, however, the rate began inching higher, hitting 59 deaths per 100,000 in 2017. For this study, investigators focused on the differences between whites and African Americans, and excluded other ethnic groups. Among adults through age 84, they noted that in 1999 heart failure–related deaths were 1.16-fold higher for African American men compared with white men, but that risk disparity escalated to 1.43-fold higher for African American men in 2017. Similarly, African American women began with a 1.35-fold higher risk of heart failure death compared with white women in 1999, but that rose to a 1.54-fold higher risk by 2017.
Why the Trend Is Greater Among African Americans
“These statistics don’t surprise me,” says Sarah Samaan, MD, a cardiologist with Baylor Scott & White Legacy Heart Center in Plano, Texas. “Heart failure is often a consequence of untreated hypertension or cardiovascular disease. Obesity, poor diet, and sedentary lifestyles are very likely the drivers of this unfortunate trend.” The CDC notes about 40 percent of all American adults are obese, but African American women have the highest rates of being overweight or obese compared with other groups in the United States, according to the U.S. Department of Health and Human Services Office of Minority Health. About 4 out of 5 African American women are overweight or obese. In addition, many African Americans live in communities where access to healthcare is limited, according to Dr. Samaan. “So diagnosis of hypertension and other predisposing conditions may not happen until they present with the more severe health consequences, including heart failure, heart attacks, and strokes,” she says. “Mistrust of the healthcare system, often based on historical inequities in treatment, may also cause some people to avoid doctors and medication until it is too late.” RELATED: Common Symptoms of Heart Failure and How It’s Diagnosed
Learn to Lower Your Risk for Heart Failure
Although more research is needed to better understand the disparities in heart failure mortality and the factors that may be contributing to these differences in outcomes, Dr. Khan stresses that heart failure is preventable. “While we don’t know all of the drivers of changing mortality rates, we do know that aggressive risk factor management is critical,” she says. “Talk to your doctor, check your blood pressure, and know your risk for heart failure.” Khan advises that this is especially critical for black men and women, who have the highest mortality rates from heart failure. With heart failure–related deaths only expected to rise in the years to come, the country appears to be backsliding in terms of health, according to study authors. They highlight how policy measures that focused on blood pressure and cholesterol control, and smoking cessation helped lower heart disease–related deaths between the 1970s and 2010. “Given the substantial mortality burden of heart failure [today], population-wide policy measures are urgently needed to eliminate racial disparities and target individuals earlier in life for heart failure prevention,” they conclude. RELATED: How to Live Longer With Heart Failure
