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Tag: African Americans with Heart Failure

African-Americans More Likely to Die from Cardiovascular Disease

According to the American Heart Association, African Americans experience significantly worsened cardiovascular health, and thus face greater mortality rates from heart disease. African Americans die an average of 3.4 years before white Americans, a gap largely attributable to prevalent cardiovascular disease and risk factors. Recent publication of a scientific statement from the organization reads: “The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites.”

Dr. Mercedes R. Carnethon from Northwestern University Preventive Medicine in Chicago states that traditional cardiovascular risk factors—including high blood pressure, diabetes, obesity, and atherosclerosis—are not only more common among African Americans, but also manifest at relatively young ages. Data indicates that high blood pressure is diagnosed in 13.8 percent of black children, compared to 8.5 percent in white children. The risk of persisting hypertension in black adults, throughout adulthood, is 1.5 times higher than in whites. “Interrupting this process by preventing the early onset of cardiovascular diseases is one strategy to reduce disparities in cardiovascular disease mortality,” Dr. Carnethon writes.

The research team at the American Heart Association notes that circumstances have remained fairly stagnant since 2005; relatively little has changed since 2005, when the same journal pointed to disparities in the rates of cardiovascular disease, disease management, and outcomes for African Americans. While genetic differences between African Americans and other groups do not account for the disparities in cardiovascular disease rates and outcomes, many of the variances arise from “unhealthy behaviors, lower implementation of guidelines shown to improve cardiovascular health, ingrained cultural preferences and attitudes, and lack of persistence in following lifestyle changes that need to be lifelong.”

While Dr. Carnethon’s team notes that cardiovascular disease is often preventable through the implementation and continued practice of a healthy, nutritious lifestyle, she discusses the difficulties faced by many African Americans—particularly those in lower income groups—in accessing the necessary resources to lead healthy lifestyles: specifically, access to healthful foods, safe spaces for physical activity and exercise, and homes that allow for restorative sleep. Moreover, she argues that despite the strides our country has made in broadening access to healthcare, many African-Americans are still unable to afford and prioritize preventive care visits.

Dr. LaPrincess Brewer from the Mayo Clinic in Rochester, Minnesota has continuously worked to promote cardiovascular health in African-American communities, promotes “culturally relevant, community-based cardiovascular health interventions that focus more on positive motivation towards promoting cardiovascular health rather than the negative impact of cardiovascular disease.” Through increased awareness, and a collective, collaborative effort on the part of clinicians, public health workers, researchers, social services, and community stakeholders, the high burden of traditional risk factors among African Americans can be addressed—in tandem with the inherent social and environmental contextual barriers faced by this specific population.

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Proposed Quality Measure Will Ensure African Americans with Heart Failure Receive the Standard of Care

A new quality measure has been submitted for consideration by the National Minority Quality Forum (NMQF) to the National Quality Forum (NQF), that if approved, will help ensure that African Americans living with heart failure (HF) will not die prematurely because they are not receiving the standard of care. Public comment began on July 23 and members of the general public are encouraged to support the proposal and comment by August 12 via the NQF’s webpage.

This past March, Dr. Keith C. Ferdinand spoke on the prevalence and severity of HF in African Americans at the Best of the CMHC Regional Conference Series.

“The harsh reality is that African Americans suffer from earlier onset and more prevalent and severe heart failure, with higher readmissions,” Dr. Ferdinand said. “These real and unfortunate disparities demand the appropriate application of evidence-based, guideline-supported pharmacotherapy in blacks. Clinicians, public health leaders, and policymakers cannot overlook this necessary responsibility to ensure the best therapy for all patients where indicated.” Plan on attending the 10th Annual CMHC Boston, October 21-24, 2015 to hear more perspective on the topic.

The new quality measure is fully supported by the Association of Black Cardiologists as well as ACC/AHA guidelines and emphasizes the importance of adherence to the current standard of care for African Americans with HF. More than 550,000 African Americans are living with HF, of whom more than 150,000 should be prescribed fixed-dose hydralazine and isosorbide dinitrate, a drug regimen proven to reduce mortality in African Americans by 43% and first-time hospitalizations for HF by 33%.

Few, however, are actually receiving this regimen. According to Dr. Gary Puckrein, CEO of the NMQF and the proposed measure’s steward, “Astonishingly, only a very small portion, about 7%, of African Americans who are clinically eligible for the therapy are getting it.”

View Dr. Keith Ferdinand’s One-Minute Clinician video interview for more insight.

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