title: Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee.
abstract: The presentation, natural history, clinical outcomes, and response to therapy in patients with heart failure differ in some ways across populations. Women, older adults, and non-Caucasian racial or ethnic groups compose a substantial proportion of the overall heart failure population, but they have typically been underrepresented in clinical trials. As a result, uncertainty exists about the efficacy of some guideline-directed medical therapies and devices in specific populations, which may result in the under- or overtreatment of these patients. Even when guideline-based treatments are prescribed, socioeconomic, physical, or psychologic factors may affect non-Caucasian and older adult patient groups to a different extent and affect the application, effectiveness, and tolerability of these therapies. Individualized therapy based on tailored biology (genetics, proteomics, metabolomics), socioeconomic and cultural considerations, and individual goals and preferences may be the optimal approach for managing diverse patients. This comprehensive approach to personalized medicine is evolving, but in the interim, the scientific community should continue efforts focused on intensifying research in special populations, prescribing guideline-directed medical therapy unless contraindicated, and implementing evidence-based strategies including patient and family education and multidisciplinary team care in the management of patients.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Monica
authors.initials: M
authors.lastname: Colvin
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Sweitzer
authors.affiliation: Nursing Institute and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.affiliation: Advanced Cardiovascular Institute, Middletown, Ohio.
authors.forename: Rajan
authors.initials: R
authors.lastname: Krishnamani
authors.affiliation: Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
authors.affiliation: Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina.
authors.forename: Wendy Gattis
authors.initials: WG
authors.lastname: Stough
authors.affiliation: Saint Vincent Heart Center, Indianapolis, Indiana.
authors.forename: Mary Norine
authors.initials: MN
authors.lastname: Walsh
authors.affiliation: School of Nursing, Azusa Pacific University, Azusa, California.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Westlake Canary
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: University of Toledo, Toledo, Ohio.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Bonnell
authors.affiliation: Georgetown University and Washington DC Veterans Affairs Medical Center, Washington, District of Columbia.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carson
authors.affiliation: University of Alberta, Edmonton, Canada.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Chan
authors.affiliation: Spectrum Health, Grand Rapids, Michigan.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Dickinson
authors.affiliation: Temple Heart and Vascular Institute, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dries
authors.affiliation: Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Ohio State University, Columbus, Ohio.
authors.forename: Ray E
authors.initials: RE
authors.lastname: Hershberger
authors.affiliation: Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Katz
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Moore
authors.affiliation: University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina.
authors.forename: Jo E
authors.initials: JE
authors.lastname: Rodgers
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Vest
authors.affiliation: Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: mgivertz@partners.org.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
mesh_terms: D000328:Adult; D005006:Ethnicity; D005260:Female; D017408:Guidelines as Topic; D006333:Heart Failure / Q000208:ethnology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D057285:Precision Medicine / Q000379:methods; D012955:Societies, Medical; D016387:Women's Health
keywords: African American; Heart failure; elderly; women