If you have heart failure, the right treatment can make all the difference in improving your symptoms and prolonging your life. Treatments range from lifestyle changes, such as cutting back on salt, to a heart transplant for the most severe cases of heart failure.
In the US, heart failure is more common in black and Hispanic people than in white people. Black people are more likely to develop heart failure at a younger age and lose their lives to the disease. Kelly McCants, MD, a cardiologist at Norton Healthcare in Louisville, Kentucky, calls it the “40/40 club.”
“Forty percent of heart failure diagnoses in our hospital occur in African Americans under the age of 40.” McCants says this startling statistic is similar to heart failure rates in other major cities with large black populations.
In addition to these health challenges, Black and Latino people face significant barriers to receiving treatment for heart failure. Research shows that these groups are less likely to:
- Care from a cardiologist if they are in the hospital and seriously ill with heart failure
- Advanced heart failure therapies such as a heart transplant
- A referral from a doctor for a cardiac rehabilitation program
- Surgery to implant heart devices
The reasons for these health disparities are complex. Things like your health insurance status, biases in the healthcare system, and a lack of representation in clinical research all play a role. Addressing these barriers can help Black and Latinx people gain equal access to treatment.
Removing barriers to the treatment of heart failure
Know your numbers
The first step in accessing treatment for heart failure is understanding your chances of developing the disease. The risk of heart failure is greater if you have conditions such as high blood pressure or diabetes. And some minority groups are more likely to live with these conditions.
McCants, who is also executive director of the Advanced Heart Failure and Recovery Program at Norton Healthcare and the Institute for Health Equity, says many Black and Hispanic people don’t know if they have high blood pressure, a leading cause of heart failure. “Most of the time we are not aware of it [blood pressure] goals in terms of the 120 over the 80.”
High blood pressure is a ‘silent killer’, so the only way to know if you have it is to check your numbers regularly. Your doctor can tell you how often you should check your blood pressure. This can be done quickly at the doctor, in the pharmacy or – with the right equipment – even at home.
Paying for healthcare
If your doctor says you have heart failure, one of the first questions you may ask is how you will pay for heart failure treatment. A diagnosis of heart failure often requires expensive medications, frequent hospital visits and close supervision by doctors.
The cost of healthcare is a crucial concern for many people, especially those who have less money. Data shows that people of color are more likely to be uninsured, underinsured and living in poverty than white people.
“When patients are faced with the choice between taking medications or having money for food, it becomes a very difficult balance,” says Jim Cheung, MD, a cardiologist and electrophysiologist at Weill Cornell Medicine in New York.
The more serious your condition, the more expensive the treatment can be. An example: a heart transplant. If you have advanced heart failure, you may need a new heart from a donor, a surgery that costs more than $1.6 million. Transplant centers require proof of health insurance or other financial resources before they can even put you on a waiting list for a new heart.
The Affordable Care Act (ACA) and Medicaid expansion have improved access to treatment for many. One study found that the number of African Americans added to heart transplant lists increased by 30% in states that expanded Medicaid. The number of Hispanics on these lists also grew, but only slightly.
Bias in the healthcare system
Your race or ethnicity may also affect how health care providers treat you for medical conditions, including heart failure. Scientific research has shown for decades that minority groups undergo fewer medical procedures and receive worse care than white people. This is partly due to unconscious biases of healthcare providers.
Researchers looked at how your race influences doctors’ decision-making about advanced therapies for heart failure. In general, race does not appear to play a role in whether doctors suggest different treatments. But if you’re black, doctors are less likely to suggest a heart transplant, especially older doctors.
Research shows that your chances of better health outcomes increase when you identify with and trust the person treating you. “It certainly helps if you can identify yourself culturally [with your provider] – if you have similar experiences or a similar background,” says McCants. “As health care systems and providers, we must reflect the communities we serve.”
“I think this will go a long way in reducing communication problems between doctors and patients,” says Cheung.
Unfortunately, it may not always be possible for Black and Hispanic people to visit a cardiologist who looks like them. Underrepresented minorities make up less than 8% of cardiologists in the US
Representation in clinical trials
Researchers conduct clinical trials to find out whether a new or existing medical treatment works or has harmful side effects. These studies rely on volunteers to test therapies and treatments. The results determine which medications and other treatments doctors will prescribe to all their patients.
But the study participants are not always a good representation of all patients. There are often many more white people in these studies than black or Hispanic people. Sometimes the study results don’t even mention the races or ethnicities of the study participants. In those cases, doctors have no way of knowing whether the treatments work equally well for people of all racial and ethnic backgrounds.
Blacks and Hispanics have long been unrepresented in clinical trials of heart failure therapies. This is despite the fact that disease rates are higher. Clinical trials involving more racial and ethnic minorities “give us a lot of insight into the impact of therapies on our patients,” Cheung says. “And not just a few patients, but all of our patients.”
In late 2022, the US Congress passed legislation calling for greater diversity in clinical trials. It requires drug sponsors to submit a diversity action plan to the FDA. The plan should include the sponsor’s enrollment goals and how it plans to achieve them. This could pave the way for research discoveries that apply to people of all skin colors and not just some.