A study by Saint Louis University researchers paints a grim picture for many heart failure patients in America – and the outlook is worse for African Americans.
The study, published in the Journal of the American Heart Association, found that only one in eight patients with heart failure nationwide receive palliative care consultations within five years of diagnosis.
Alarmingly, Black people were 15% less likely to receive palliative care compared to white patients with similar heart health illness.
Other recent respective studies illustrate the higher risk and mortality rates for cardiovascular disease in the Black population – further demonstrating that the missing palliative care options have a greater negative impact on African American health.
New statistics from a medical team at EHproject show African American women are at a greater risk for cardiovascular disease than their white counterparts. It found that 47.3% of Black women have heart disease. If they do not have it currently, they are 2.4 times more likely to develop heart disease.
The report also found Black women to have the highest rate of hypertension, coronary artery disease, heart failure and stroke than women of any other ethnic group in the United States. According to the data, the average age for a Black woman to experience a heart attack is 72 compared to age 74 for white women.
A March 2023 study published in JAMA Cardiology showed that Black men remain at the highest risk of dying from cardiovascular disease. (The age-adjusted mortality rate from cardiovascular disease for Black men in 2019 was 245 per 100,000, compared with 191 per 100,000 for white men and 135 per 100,000 for Hispanic men.)
What is palliative care?
According to the Mayo Clinic, palliative care focuses on providing relief from pain and other symptoms of a serious illness. It can also help patients understand and monitor side effects from medical treatments.
A palliative care team, which can include doctors, nurses, social workers, and other trained specialists, collaborates with patients and families “to add an extra layer of support and relief that complements ongoing care.”
The American Heart Association (AHA) and European Society of Cardiology recommend integrating palliative care into managing heart failure.
“Anecdotal reports suggest that most patients with heart failure do not receive palliative care, and those who do typically receive it only in the last two to three weeks of life,” Zidong Zhang, Ph.D., said in a SLU release.
Zhang, a research scientist at the AHEAD Institute at SLU’s School of Medicine and the paper’s senior and corresponding author, said, “this is the first study to investigate the uptake of palliative care consultation following a heart failure diagnosis in the general U.S. population.”
“Unlike the previous studies focusing on Medicare beneficiaries or veterans, our research provides a more general insight into early palliative care integration for heart failure across the entire nation,” he explained.
Zhang and his co-authors analyzed data from a national all-payer database covering 2011 to 2018. The study cohort included nearly 170,000 patients aged 18 to 80 from throughout America.
Some had advanced heart failure or had received advanced therapies such as left ventricular assist devices or cardioversion.
The AHA recommends early integration of palliative care consultation for all patients with heart failure,” particularly when evaluating patients for advanced therapies.”
Increasing the number of patients who receive palliative care “might include removing barriers in the payment system.”
The systemic change could clear a way for concurrent care, assisting physicians in determining when to initiate the palliative care conversation with patients, and, in a health system, expanding outpatient and community-based palliative care service,” said Zhang.
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