Ethnic Disparities in Outcomes of Heart Failure in the United States

African descent man clutching his chest in pain with a possible heart attack.
Ethnic disparities persist for treatment and clinical outcomes among patients with heart failure in the United States.

Ethnic disparities persist for treatment and clinical outcomes among patients with heart failure (HF) in the United States (US), according to results from a contemporary cohort study published in the Journal of the American Heart Association.

This study was from the Kaiser Permanente Northern California healthcare system, in which data of >4.5 million members treated across 21 hospitals were examined. Adults (n=34,621; mean age, 74.3±12.3 years; 54.1% men) diagnosed with HF between 2012 and 2016 were assessed for hospitalizations and clinical outcomes through 2017.

In this cohort, 59.3% of patients had HF with preserved ejection fraction (HFpEF), 23.2% had HF with reduced (HFrEF), 17.5% had midrange EF, 35.5% had prevalent HF, and 66.1% were White, 11.9% Hispanic, 11.5% Asian or Pacific Islander, and 10.5% Black. Baseline comorbidities and demographics were similar across ethnicities, but White patients were older and less likely to live in highest deprivation quintile.

Black patients had the highest rate of hospitalization for HF (17.8 per 100 person-years [py]), HF was least frequent among Asian or Pacific Islanders (53.0 per 100 py), and HF-related mortality was highest among White patients (12.4 per 100 py).

Hospitalization for HF was more likely among Black patients (adjusted hazard ratio [aHR], 1.28; 95% CI, 1.18-1.38) and any hospitalization was less likely among Asian or Pacific Islanders (aHR, 0.89; 95% CI, 0.85-0.93) compared with White patients.

All-cause mortality was lower among Asian or Pacific Islanders (aHR, 0.75; 95% CI, 0.69-0.80), Black (aHR, 0.78; 95% CI, 0.72-0.85), and Hispanic (aHR, 0.85; 95% CI, 0.80-0.91) patients compared with White patients.

Black vs White patients with HFrEF were more likely to be hospitalized (aHR, 1.35; 95% CI, 1.18-1.55), but had lower mortality risk (aHR, 0.70; 95% CI, 0.60-0.80). Similar patterns were observed among patients with HFpEF for hospitalizations (aHR, 1.19; 95% CI, 1.07-1.33) and mortality (aHR, 0.82; 95% CI, 0.74-0.91).

This study may have been limited by the lack of inclusion of potential confounders such as lifestyle characteristics and genetic risk.

“Future efforts are needed to better understand explanatory mechanisms for these observations and effective interventions to reduced adverse HF-related outcomes across all racial/ethnic groups,” concluded the study authors.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Savitz S T, Leong T, Sung S H, et al. Contemporary Reevaluation of Race and Ethnicity With Outcomes in Heart Failure. J Am Heart Assoc. 2021;10(3):e016601. doi:10.1161/JAHA.120.016601