Disparities in Heart Failure Management in Older Adults

Purpose of the Review:: Patients with a heart failure diagnosis face early mortality and impaired quality of life. Optimal management requires close follow up and appropriate management of guideline-directed medial therapy (GDMT). The purpose of this review is to identify the sources of outcome disparities amongst elderly patients with heart failure, examine which can be acted upon, and propose potential measures to improve care moving forward. Recent Findings:: Disparities in heart failure outcomes have been observed in comparing the older population to the younger, in blacks or Hispanics vs. whites, and in male vs. female patients. Many disparities on further analysis in recent studies has revealed common causes amongst these groups. Underutilization of GDMT is a major driver of worse outcomes and prognosis. In addition, many disparities previously attributed to race have their underlying cause in access to heart failure-specialized care in lower socioeconomic regions. Lastly, uncontrolled comorbidities, particularly kidney disease, chronic obstructive pulmonary disease (COPD), depression, and atrial fibrillation are associated with worse outcomes and are more prevalent with advancing age, blacks, and men. Summary:: Disparities in HF management are a result of underutilization of GDMT, limited access to care in low socioeconomic status or rural areas, and uncontrolled comorbidities. Improving care in this population requires a broad approach including community based clinics or partnerships with established primary care offices, protocols for GDMT initiation and dose adjustments, and comprehensive management of not only heart failure but a patient’s other comorbidities.