Treatment of Heart Failure in African Americans— A Call to Action
Advances in heart failure treatment have not necessarily translated into equity in improved outcomes for African Americans. Heart failure in African Americans is characterized by a higher prevalence, especially at younger ages; more-adverse course with more frequent hospitalizations; and higher mort...
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| Veröffentlicht in: | Journal of the National Medical Association 2011-02, Vol.103 (2), p.86-98 |
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| creator | Mitchell, Judith E., MD Ferdinand, Keith C., MD Watson, Karol E., MD, PhD Wenger, Nanette K., MD Watkins, Laurence O., MD, MPH Flack, John M., MD, MPH Gavin, James R., MD, PhD Reed, James W., MD Saunders, Elijah, MD Wright, Jackson T., MD, PhD |
| description | Advances in heart failure treatment have not necessarily translated into equity in improved outcomes for African Americans. Heart failure in African Americans is characterized by a higher prevalence, especially at younger ages; more-adverse course with more frequent hospitalizations; and higher mortality rates compared to the general population. Despite this distinct disease profile, African Americans are remarkably underrepresented in large heart failure trials. This paper reviews the unique course of heart failure in African Americans and discusses treatment in the context of clinical trial evidence. African Americans with heart failure may respond differently to some standard therapies compared to whites, but low levels of enrollment of AAs in large clinical trials preclude valid conclusions in certain cases. An important exception is the African American Heart Failure Trial (AHeFT), a well-designed, prospective, randomized, placebo-controlled, double-blind study, that added a combination of fixed-dose isosorbide dinitrate/hydralazine (ISDN/ HYD) to standard therapy and showed a 43% improvement in survival and a 33% reduction in first hospitalizations. Despite compelling evidence from AHeFT, post hoc secondary analyses, and recommendations from current practice guidelines, ISDN/HYD remains underutilized in African Americans with heart failure. In this paper, we put forth a call to action for racial equity in clinical research and treatment in African Americans with heart failure. |
| doi_str_mv | 10.1016/S0027-9684(15)30257-1 |
| format | Article |
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Heart failure in African Americans is characterized by a higher prevalence, especially at younger ages; more-adverse course with more frequent hospitalizations; and higher mortality rates compared to the general population. Despite this distinct disease profile, African Americans are remarkably underrepresented in large heart failure trials. This paper reviews the unique course of heart failure in African Americans and discusses treatment in the context of clinical trial evidence. African Americans with heart failure may respond differently to some standard therapies compared to whites, but low levels of enrollment of AAs in large clinical trials preclude valid conclusions in certain cases. An important exception is the African American Heart Failure Trial (AHeFT), a well-designed, prospective, randomized, placebo-controlled, double-blind study, that added a combination of fixed-dose isosorbide dinitrate/hydralazine (ISDN/ HYD) to standard therapy and showed a 43% improvement in survival and a 33% reduction in first hospitalizations. Despite compelling evidence from AHeFT, post hoc secondary analyses, and recommendations from current practice guidelines, ISDN/HYD remains underutilized in African Americans with heart failure. In this paper, we put forth a call to action for racial equity in clinical research and treatment in African Americans with heart failure.</description><identifier>ISSN: 0027-9684</identifier><identifier>EISSN: 1943-4693</identifier><identifier>DOI: 10.1016/S0027-9684(15)30257-1</identifier><identifier>PMID: 21443060</identifier><identifier>CODEN: JNMAAE</identifier><language>eng</language><publisher>Washington, DC: Elsevier Inc</publisher><subject>African Americans ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; clinical trial ; Clinical Trials as Topic ; drugs ; General aspects ; Heart ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - epidemiology ; Heart Failure - ethnology ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; hypertension ; Internal Medicine ; Medical sciences ; Risk Factors ; treatment ; United States - epidemiology</subject><ispartof>Journal of the National Medical Association, 2011-02, Vol.103 (2), p.86-98</ispartof><rights>National Medical Association</rights><rights>2011 National Medical Association</rights><rights>2015 INIST-CNRS</rights><rights>2011. National Medical Association</rights><rights>Copyright National Medical Association Feb 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c504t-2676244bb5aa965d689961d77b4b39b31fc4d2b781a952d2196dd75944e273193</citedby><cites>FETCH-LOGICAL-c504t-2676244bb5aa965d689961d77b4b39b31fc4d2b781a952d2196dd75944e273193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23917291$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21443060$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mitchell, Judith E., MD</creatorcontrib><creatorcontrib>Ferdinand, Keith C., MD</creatorcontrib><creatorcontrib>Watson, Karol E., MD, PhD</creatorcontrib><creatorcontrib>Wenger, Nanette K., MD</creatorcontrib><creatorcontrib>Watkins, Laurence O., MD, MPH</creatorcontrib><creatorcontrib>Flack, John M., MD, MPH</creatorcontrib><creatorcontrib>Gavin, James R., MD, PhD</creatorcontrib><creatorcontrib>Reed, James W., MD</creatorcontrib><creatorcontrib>Saunders, Elijah, MD</creatorcontrib><creatorcontrib>Wright, Jackson T., MD, PhD</creatorcontrib><title>Treatment of Heart Failure in African Americans— A Call to Action</title><title>Journal of the National Medical Association</title><addtitle>J Natl Med Assoc</addtitle><description>Advances in heart failure treatment have not necessarily translated into equity in improved outcomes for African Americans. Heart failure in African Americans is characterized by a higher prevalence, especially at younger ages; more-adverse course with more frequent hospitalizations; and higher mortality rates compared to the general population. Despite this distinct disease profile, African Americans are remarkably underrepresented in large heart failure trials. This paper reviews the unique course of heart failure in African Americans and discusses treatment in the context of clinical trial evidence. African Americans with heart failure may respond differently to some standard therapies compared to whites, but low levels of enrollment of AAs in large clinical trials preclude valid conclusions in certain cases. An important exception is the African American Heart Failure Trial (AHeFT), a well-designed, prospective, randomized, placebo-controlled, double-blind study, that added a combination of fixed-dose isosorbide dinitrate/hydralazine (ISDN/ HYD) to standard therapy and showed a 43% improvement in survival and a 33% reduction in first hospitalizations. Despite compelling evidence from AHeFT, post hoc secondary analyses, and recommendations from current practice guidelines, ISDN/HYD remains underutilized in African Americans with heart failure. In this paper, we put forth a call to action for racial equity in clinical research and treatment in African Americans with heart failure.</description><subject>African Americans</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>clinical trial</subject><subject>Clinical Trials as Topic</subject><subject>drugs</subject><subject>General aspects</subject><subject>Heart</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - ethnology</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>hypertension</subject><subject>Internal Medicine</subject><subject>Medical sciences</subject><subject>Risk Factors</subject><subject>treatment</subject><subject>United States - epidemiology</subject><issn>0027-9684</issn><issn>1943-4693</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkc2KFDEUhYMoTtv6CEqhiLoozc1v3Y1D0ziOMODCcR1SqRRkrJ8xqRJm50PME_okprrbFgbE1c3iu-eenEPIU6BvgYJ694VSpktUlXgN8g2nTOoS7pEVoOClUMjvk9UROSGPUrqilFYo5UNywkAIThVdke1l9Hbq_TAVY1ucexun4syGbo6-CEOxaWNwNs_e7x7p18_bYlNsbdcV01hs3BTG4TF50Nou-SeHuSZfzz5cbs_Li88fP203F6WTVEwlU1oxIepaWotKNqpCVNBoXYuaY82hdaJhta7AomQNA1RNoyUK4ZnmgHxNXu11r-P4ffZpMn1IznedHfw4J1NJZBXyHMCaPL9DXo1zHLI5U4l8FKlWGXrxL4ixiiMwxOWo3FMujilF35rrGHobbwxQszRhdk2YJWYD0uyaMJD3nh3U57r3zXHrT_QZeHkAbHK2a6MdXEh_uWxAM1yETvecz9H-CD6a5IIfnG9C9G4yzRj-a-X9HQXXhSHX2X3zNz4dfw0mMUP3IosGyJ0C8N95ebXc</recordid><startdate>20110201</startdate><enddate>20110201</enddate><creator>Mitchell, Judith E., MD</creator><creator>Ferdinand, Keith C., MD</creator><creator>Watson, Karol E., MD, PhD</creator><creator>Wenger, Nanette K., MD</creator><creator>Watkins, Laurence O., MD, MPH</creator><creator>Flack, John M., MD, MPH</creator><creator>Gavin, James R., MD, PhD</creator><creator>Reed, James W., MD</creator><creator>Saunders, Elijah, MD</creator><creator>Wright, Jackson T., MD, PhD</creator><general>Elsevier Inc</general><general>National Medical Association</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20110201</creationdate><title>Treatment of Heart Failure in African Americans— A Call to Action</title><author>Mitchell, Judith E., MD ; Ferdinand, Keith C., MD ; Watson, Karol E., MD, PhD ; Wenger, Nanette K., MD ; Watkins, Laurence O., MD, MPH ; Flack, John M., MD, MPH ; Gavin, James R., MD, PhD ; Reed, James W., MD ; Saunders, Elijah, MD ; Wright, Jackson T., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c504t-2676244bb5aa965d689961d77b4b39b31fc4d2b781a952d2196dd75944e273193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>African Americans</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>clinical trial</topic><topic>Clinical Trials as Topic</topic><topic>drugs</topic><topic>General aspects</topic><topic>Heart</topic><topic>Heart failure</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - ethnology</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>hypertension</topic><topic>Internal Medicine</topic><topic>Medical sciences</topic><topic>Risk Factors</topic><topic>treatment</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mitchell, Judith E., MD</creatorcontrib><creatorcontrib>Ferdinand, Keith C., MD</creatorcontrib><creatorcontrib>Watson, Karol E., MD, PhD</creatorcontrib><creatorcontrib>Wenger, Nanette K., MD</creatorcontrib><creatorcontrib>Watkins, Laurence O., MD, MPH</creatorcontrib><creatorcontrib>Flack, John M., MD, MPH</creatorcontrib><creatorcontrib>Gavin, James R., MD, PhD</creatorcontrib><creatorcontrib>Reed, James W., MD</creatorcontrib><creatorcontrib>Saunders, Elijah, MD</creatorcontrib><creatorcontrib>Wright, Jackson T., MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the National Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mitchell, Judith E., MD</au><au>Ferdinand, Keith C., MD</au><au>Watson, Karol E., MD, PhD</au><au>Wenger, Nanette K., MD</au><au>Watkins, Laurence O., MD, MPH</au><au>Flack, John M., MD, MPH</au><au>Gavin, James R., MD, PhD</au><au>Reed, James W., MD</au><au>Saunders, Elijah, MD</au><au>Wright, Jackson T., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of Heart Failure in African Americans— A Call to Action</atitle><jtitle>Journal of the National Medical Association</jtitle><addtitle>J Natl Med Assoc</addtitle><date>2011-02-01</date><risdate>2011</risdate><volume>103</volume><issue>2</issue><spage>86</spage><epage>98</epage><pages>86-98</pages><issn>0027-9684</issn><eissn>1943-4693</eissn><coden>JNMAAE</coden><abstract>Advances in heart failure treatment have not necessarily translated into equity in improved outcomes for African Americans. Heart failure in African Americans is characterized by a higher prevalence, especially at younger ages; more-adverse course with more frequent hospitalizations; and higher mortality rates compared to the general population. Despite this distinct disease profile, African Americans are remarkably underrepresented in large heart failure trials. This paper reviews the unique course of heart failure in African Americans and discusses treatment in the context of clinical trial evidence. African Americans with heart failure may respond differently to some standard therapies compared to whites, but low levels of enrollment of AAs in large clinical trials preclude valid conclusions in certain cases. An important exception is the African American Heart Failure Trial (AHeFT), a well-designed, prospective, randomized, placebo-controlled, double-blind study, that added a combination of fixed-dose isosorbide dinitrate/hydralazine (ISDN/ HYD) to standard therapy and showed a 43% improvement in survival and a 33% reduction in first hospitalizations. Despite compelling evidence from AHeFT, post hoc secondary analyses, and recommendations from current practice guidelines, ISDN/HYD remains underutilized in African Americans with heart failure. In this paper, we put forth a call to action for racial equity in clinical research and treatment in African Americans with heart failure.</abstract><cop>Washington, DC</cop><pub>Elsevier Inc</pub><pmid>21443060</pmid><doi>10.1016/S0027-9684(15)30257-1</doi><tpages>13</tpages></addata></record> |
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| subjects | African Americans Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system clinical trial Clinical Trials as Topic drugs General aspects Heart Heart failure Heart Failure - drug therapy Heart Failure - epidemiology Heart Failure - ethnology Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans hypertension Internal Medicine Medical sciences Risk Factors treatment United States - epidemiology |
| title | Treatment of Heart Failure in African Americans— A Call to Action |
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