Congestive Heart Failure (CHF) In African Americans

CHF affects almost 5 million Americans, with about 500,000 new cases reported each year. The estimated yearly cost to the nation is $10 billion.

There are substantial differences between blacks and whites with heart failure regarding age, incidence, etiology, hospitalization rates, left ventricular hypertrophy, left ventricular function, clinical follow-up, and mortality. Although the data concerning black-white differences is not voluminous, there have been some studies performed which help to shed light on these disparities and their impact on patient survival. For example, one study showed that African Americans under age 65 with CHF have 2.5 times the mortality experienced by whites of the same ages. When patients older than 65 were considered, the age-adjusted death rate in 1990 for CHF was 143.9 for African American men compared to 117.8 for white men, and 113.4 for African American women compared to white females. Medicare data have also demonstrated higher rates of admission and discharge diagnoses of CHF for blacks.

It has been stated often that African Americans have a greater prevalence of hypertensive heart disease as opposed to ischemic heart disease as the underlying etiology of their CHF, and that whites have the reverse situation. These beliefs are borne out in the Study of Left Ventricular Dysfunction (SOLVD) trial, in which blacks with CHF had a higher prevalence of hypertensive heart disease and a lower prevalence of ischemic heart disease.