Search

Heart failure (HF) affects6 million Americans, with variations in incidence, prevalence, and clinical outcomes by race/ethnicity. Black adults have the highest risk for HF, with earlier age of onset and the highest risk of death and hospitalizations. The risk of hospitalizations for Hispanic patients is higher than White patients. Data on HF in Asian individuals are more limited. However, the higher burden of traditional cardiovascular risk factors, particularly among South Asian adults, is associated with increased risk of HF. The role of environmental, socioeconomic, and other social determinants of health, more likely for Black and Hispanic patients, are increasingly recognized as independent risk factors for HF and worse outcomes. Structural racism and implicit bias are drivers of health care disparities in the United States. This paper will review the clinical, physiological, and social determinants of HF risk, unique for race/ethnic minorities, and offer solutions to address systems of inequality that need to be recognized and dismantled/eradicated.

Objectives To develop a novel set of graphical Mini‐Cog instructions designed to aid clinicians previously untrained on the Mini‐Cog in accurate administration and scoring and to determine whether use of these graphical instructions improved the speed and accuracy of deployment of this tool. Design Randomized clinical trial. Setting Testing was conducted in a simulated environment with a mock patient. Participants Registered nurses working in inpatient or outpatient settings at a large academic medical center who had no prior exposure to or training with the Mini‐Cog (N=92). Measurements Our primary outcome was the composite proportion of nurses who made errors in administration or scoring of the Mini‐Cog. Results None of the nurses in the graphical instruction group and 28 (61%) in the standardized instructions group (15 (33%) made administration errors, 22 (48%) made scoring errors) made errors. Nurses randomly assigned to the graphical group were able to read (median 36 vs 54 seconds, P

The prevalence of heart failure (HF) continues to grow in the USA, and approximately 50% of these patients are women. Despite this, there has been an underrepresentation of women in HF clinical trials, which has led to limitations in understanding of sex-related differences in HF pathophysiology, diagnosis, and treatment. The purpose of this review is to highlight the differences between men and women in various heart failure trials conducted in the last century and emphasize new findings from recent trials in the management of, and outcomes in, women with HF. HF trials have shown that women have improved survival with guideline-directed medical therapy, and the most recent analysis from PARADIGM-HF showed women had lower mortality and hospitalization rate compared with men. Furthermore, despite comprising only 20% of subjects in cardiac resynchronization therapy (CRT) trials, we now know that women are likely to benefit from a CRT device, in particular those with left bundle branch block. Advanced therapies for heart failure including durable mechanical circulatory support remain underused in women, and female patients are less likely to undergo heart transplantation when compared with men of similar risk profiles. The latest studies have shown women receiving continuous-flow left ventricular assist device support had lower chances of heart transplantation, increased risk of waitlist mortality, and higher rates of delisting for worsening clinical status. However, post transplantation, women have better survival when compared with men. Although several studies have shown that women with HF live longer than men, they experience greater self-reported psychological and physical disability and poorer overall quality of life. The cause of sex differences in morbidity and mortality remains unknown, but as the therapeutic options for HF expand, sex-based differences in treatment would need to be considered.