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Unequitable Heart Failure Therapy for Black, Hispanic and American-Indian Patients

Onyedika Ilonze1, Kendall Free2, Khadijah Breathett1

  • 1Division of Cardiovascular Medicine, Krannert Cardiovascular Institute, Indiana University Indianapolis, IN, US.

Cardiac Failure Review
|July 22, 2022
PubMed

Insights

Black and Hispanic heart failure patients often miss guideline-directed medical therapy (GDMT). Addressing systemic barriers like bias and distrust is crucial to improve GDMT uptake in patients of color.

Area of Science:

  • Cardiology
  • Health Equity
  • Health Services Research

Background:

  • Heart failure disproportionately affects Black and Hispanic populations.
  • Patients of color are less likely to receive guideline-directed medical therapy (GDMT) for heart failure.
  • American-Indian populations with heart failure remain undercharacterized.

Purpose of the Study:

  • To highlight the underprescription of GDMT in patients of color with heart failure.
  • To identify contributing factors to this disparity, including clinical inertia, financial toxicity, and systemic bias.
  • To propose evidence-based strategies for increasing GDMT uptake in these populations.

Main Methods:

  • This study synthesizes existing literature and expert opinion.
  • It identifies key barriers to GDMT implementation in minority populations.
  • It postulates actionable strategies for improving care.

Main Results:

  • Key barriers include clinical inertia, financial toxicity, trial underrepresentation, mistrust in medical systems, bias, and structural racism.
  • These factors contribute to the underprescription of GDMT.
  • Specific strategies are proposed to overcome these challenges.

Conclusions:

  • There is an urgent need for evidence-based interventions to improve GDMT uptake in heart failure patients of color.
  • Strategies include immediate GDMT prescription, aggressive uptitration, addressing social determinants of health, and combating bias.
  • Stakeholder engagement and national quality improvement programs are essential.

Keywords:
Heart failureguideline-directed medical therapyhealth disparities

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