Review: Heart failure with preserved ejection fraction in African Americans

Heart failure (HF) affects 5,700 000 people in the United States, with heart failure with preserved ejection fraction (HFPEF) being responsible for between 30%-50% of acute admissions. Epidemiological studies and HF registries have found HFPEF patients to be older, hypertensive and to have a history of atrial fibrillation. These findings, however, may not be fully applicable to African Americans, as they have been poorly studied making up only a minority of the test subjects. This review article is intended to discuss the pathophysiology and epidemiology of HFPEF within African Americans, highlight the differences compared to Caucasian populations and review current treatment guidelines. Studies looking at African Americans in particular have shown them to be younger, female and have worse diastolic dysfunction compared to Caucasian populations. African Americans also have been shown to have a worse mortality outcome especially in patients without coronary artery disease. The treatment of HFPEF is primarily symptomatic with no survival benefit seen in randomized controlled trials. Mechanisms postulated for the worse prognosis in African Americans with HFPEF include: greater incidence of hypertension and diastolic dysfunction, undefined race-driven genetic predispositions or relative resistance to medications that treat HF in general. The biological predispositions may also be compounded by inequality of healthcare access; something still felt to exist today. Prospective studies and randomized controlled trials need to be conducted with particular emphasis on African American populations to fully elucidate this disease and to formulate race specific treatment outcomes for the future.