p.80 抽出テキスト

May 3, 2022 Circulation. 2022;145:e895–e1032. DOI: 10.1161/CIR.0000000000001063 e974

CLINICAL STATEMENTS AND GUIDELINES

cruzi, with 20% progressing to Chagas cardiomyopathy.38 Diabetes is highly prevalent in Southeast Asian and Pacific Islander populations and more strongly associated with poor HF outcomes.39,40 Among patients with established HF, social and medical vulnerabilities can impede successful delivery of GDMT and are associated with poorer outcomes.5,41 Among older adults, low income, social isolation, and lack of caregiver support increase HF mortality and low QOL.9,18,42 Nursing home residents, and elderly inpatients with acute HF, are at risk of inadequate GDMT prescription,

Table 27.  Risk of HF and Outcomes in Special Populations Vulnerable Population Risk of HF HF Outcomes Women The lifetime risk of HF is equivalent between sexes, but HFpEF risk is higher in women—in FHS participants with new-onset HF, odds of HFpEF (EF >45%) are 2.8-fold higher in women than in men.66

Sex-specific differences in the predictive value of cardiac biomarkers for incident HF.67 Nontraditional cardiovascular risk factors, including anxiety, depression, caregiver stress, and low household income may contribute more toward incident heart disease in women than men.68 Overall, more favorable survival with HF than men. In the OPTI- MIZE-HF registry, women with acute HF had a lower 1-y mortality (HR, 0.93; 95% CI, 0.89–0.97), although women are more likely not to receive optimal GDMT.20,69–71

Lower patient-reported quality of life for women with HFrEF, compared with men.10,71 Greater transplant waitlist mortality for women but equivalent survival after heart transplantation or LVAD implantation.24,52

Older adults Per FHS, at 40 y of age, the lifetime risk of incident HF is 20% for both sexes; at 80 y of age, the risk remains 20% for men and women despite the shorter life expectancy.72

LVEF is preserved in at least two-thirds of older adults with the diagnosis of HF.73 Among 1233 patients with HF aged ≥80 y, 40% mortality during mean 27-mo follow-up; survival associated with prescription of GDMT.74

Lower socioeconomic status populations Among 27 078 White and Black adults of low income (70% earned <$15 000/y) participating from 2002–2009 in the Southern Community Cohort Study, a 1 interquartile increase in neighborhood deprivation index was associated with a 12% increase in risk of HF (adjusted HR, 1.12; 95% CI, 1.07–1.18).46 Age-adjusted 1999–2018 HF mortality (deaths/100 000; mean and 95% CI) was higher with increasing quartiles of ADI, which is based on 17 indicators of employment, poverty, and education:

Quartile 1, 20.0 (19.4–20.5); Quartile 2, 23.3 (22.6–24.0); Quartile 3, 26.4 (25.5–27.3); Quartile 4, 33.1 (31.8–34.4).6

Black populations In MESA, patients of Black race had highest risk of incident HF (4.6/1000 person-years) and highest proportion of nonischemic incident HF.26

Higher prevalence of HF risk factors including hypertension, obesity, and diabetes, compared with White populations.75 CDC data show race-based differences in HF mortality over time: Black men had a 1.16-fold versus 1.43-fold higher age-adjusted HF-related CVD death rate compared with White men in 1999 versus 2017; Black women had a 1.35-fold versus 1.54-fold higher age-adjusted HF-related CVD death rate compared with White women in 1999 versus 2017.27

Gap in outcomes is more pronounced among younger adults (35– 64 y of age) versus older adults (65–84 y of age); age-adjusted HF-related CVD death rates were 2.60-fold and 2.97-fold higher in young Black versus White men and women, respectively.27 Higher rates of hospitalization3 and mortality among patients with HFpEF.76 Lower 5-year survival after heart transplant.77–79

Hispanic populations MESA study showed higher HF incidence in Hispanic compared with non-Hispanic White groups (3.5 versus 2.4 per 1000 person-years) but lower than for African Americans (4.6/1000 person-years).7,26,80 Despite higher rates of hospitalization for HF compared with non- Hispanic Whites, Hispanic patients with HF have shown lower short-term mortality rates.81

In GWTG, Hispanic patients with HFpEF had lower mortality (OR, 0.50; 95% CI, 0.31–0.81) than non-Hispanic Whites, but this was not the case for Hispanic patients with HFrEF (OR, 0.94; 95% CI, 0.62–1.43).82 Lower risk of developing AF in the setting of HF, compared with White patients.83

Asian and Pacific Islander populations Limited population-specific data for Asian and Pacific Islander subgroups in the United States.84,85 High rates of preventable HF hospitalization observed in some Asian and Pacific Islander populations.13

Lower mortality rates from HF for Asian subgroups when listed as the primary cause of death, compared with non-Hispanic White groups.86

Native American and Alaskan Native populations Limited population-specific data, with cardiovascular risk factor trends best characterized by the Strong Heart Study and Strong Heart Family Study, demonstrating high rates of hypertension and diabetes.11,87 Limited data suggest HF mortality rates in American Indians and Alaska Natives are similar to those in White populations.88 CDC indicates Centers for Disease Control and Prevention; CVD, cardiovascular disease; FHS, Framingham Heart Study; GDMT, guideline-directed medical therapy; GWTG, Get With The Guidelines registry; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HR, hazard ratio; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; MESA, Multi-Ethnic Study of Atherosclerosis; OPTMIZE-HF, Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure; and OR, odds ratio.

Downloaded from http://ahajournals.org by on October 7, 2026