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Published on: June 10, 2025
Race and Ethnicity in Heart Failure: JACC Focus Seminar 8/9
Ileana L Piña1, Shirin Jimenez2, Eldrin F Lewis2
1Central Michigan University, Cleveland, Ohio, USA.
Insights
Black and Hispanic adults face higher heart failure (HF) risks and worse outcomes due to social determinants and systemic inequities. Addressing these disparities is crucial for improving HF care across diverse populations.
Area of Science:
- Cardiology
- Health Disparities
- Social Determinants of Health
Background:
- Heart failure (HF) impacts over 6 million Americans, with significant racial/ethnic disparities in incidence, prevalence, and outcomes.
- Black adults exhibit the highest HF risk, earlier onset, and greater mortality and hospitalization rates.
- Hispanic patients face higher hospitalization risks than White patients, while data on Asian populations are limited but suggest increased risk due to cardiovascular factors.
Purpose of the Study:
- To review the clinical, physiological, and social determinants of heart failure (HF) risk specific to racial and ethnic minorities.
- To examine the impact of structural racism and implicit bias on healthcare disparities in HF.
- To propose solutions for dismantling systems of inequality contributing to HF disparities.
Main Methods:
- Literature review and synthesis of existing data on heart failure (HF) risk factors across racial and ethnic groups.
- Analysis of the role of social determinants of health, environmental factors, and socioeconomic status in HF outcomes.
- Examination of the influence of structural racism and implicit bias on healthcare access and quality for minority populations.
Main Results:
- Racial and ethnic minorities, particularly Black and Hispanic adults, experience a disproportionately higher burden of heart failure (HF).
- Social determinants of health, environmental factors, and socioeconomic status are identified as significant independent risk factors for HF and adverse outcomes.
- Structural racism and implicit bias are recognized as key drivers of healthcare disparities in HF care and outcomes.
Conclusions:
- Heart failure (HF) risk and outcomes are significantly influenced by race/ethnicity, compounded by social determinants of health and systemic inequities.
- Addressing structural racism, implicit bias, and social determinants is essential to reduce HF disparities.
- Targeted interventions and policy changes are needed to ensure equitable heart failure (HF) care and improve outcomes for all populations.
Abstract:
Heart failure (HF) affects >6 million Americans, with variations in incidence, prevalence, and clinical outcomes by race/ethnicity. Black adults have the highest risk for HF, with earlier age of onset and the highest risk of death and hospitalizations. The risk of hospitalizations for Hispanic patients is higher than White patients. Data on HF in Asian individuals are more limited. However, the higher burden of traditional cardiovascular risk factors, particularly among South Asian adults, is associated with increased risk of HF. The role of environmental, socioeconomic, and other social determinants of health, more likely for Black and Hispanic patients, are increasingly recognized as independent risk factors for HF and worse outcomes. Structural racism and implicit bias are drivers of health care disparities in the United States. This paper will review the clinical, physiological, and social determinants of HF risk, unique for race/ethnic minorities, and offer solutions to address systems of inequality that need to be recognized and dismantled/eradicated.
