Racial and Ethnic Disparities in Heart Failure with Preserved Ejection Fraction: Epidemiology, Diagnosis, Management and Outcomes

Abstract Purpose of Review This review discusses the state of racial and ethnic inequities in heart failure with preserved ejection fraction (HFpEF) focusing on disease burden, risk factors, management, and outcomes. The review also highlights an implementation science-based framework for alleviating disparities and improving quality equitable care. Recent Findings HFpEF is common, underdiagnosed, and characterized by uneven distribution of risk factors across racial and ethnic groups. Modest advances in HFpEF therapeutic agents have been made recently but access may be suboptimal in minoritized racial and ethnic groups. Phenocopies of HFpEF are also increasingly being recognized in Black populations. Summary Despite recent advances in understanding the pathophysiological mechanisms, diagnosis, and treatment, HFpEF remains under-recognized in Black and Hispanic patients. Racial and ethnic inequities undergird disparities across the continuum of HFpEF care from access to specialized cardiovascular care to the utilization of guideline-directed therapies. Sodium-glucose cotransport 2 inhibitors are effective in HFpEF but are underutilized in minoritized racial and ethnic groups. There is a need for increased diagnostic certainty of phenocopies of HFpEF such as cardiac amyloidosis and hypertensive heart disease. Multi-pronged strategic interventions are critically needed to decrease racial and ethnic disparities across the HFpEF care continuum and foster improved outcomes for all patients. Key points •Racial and ethnic disparities in heart failure including HFpEF are widely prevalent and influence adverse outcomes. • Underdiagnosis of HFpEF is a common diagnostic challenge often encountered clinically as “unexplained dyspnea”. • Biological factors (such as low levels of brain natriuretic peptide in African Americans) and other operational factors such as the application of clinical risk scores derived from non-diverse cohorts may diminish ascertainment of HFpEF diagnosis in African American patients. • Phenocopies of HFpEF such as infiltrative cardiomyopathies, hypertensive heart disease, and/or HCM need to be considered in the diagnostic schema of unexplained dyspnea. • Guideline-directed pharmacologic therapy and cardiac rehabilitation are generally underutilized in racial and ethnic minority groups. • Implementation science-based approaches that incorporate social determinants of health are required to achieve health equity and optimize HFpEF care.