Matters of the Heart Caring for Your African American Patients with CVD

Course Pre-Test

Cardiology Symposium: Overview of Heart Failure - Course Survey
Ischemic Heart disease due to scarring and distortion of the myocardium
Non ischemic cardiomyopathy due to toxins such as cocaine and ETOH
Hypertension is the leading etiology of HF in blacks both for preserved and reduced LV function
All of the above

Have longer hospital stays but less readmission for Heart Failure (HF)
Readmission rates are reduced for men but not for women
Are more likely to benefit from fixed dosed Isosorbide Dinitrate/Hydralazine on top of background HF therapy
All of the above is true

They address the circumstances one’s culture, socioeconomic status, language, etc.
They can contribute to less referrals for appropriate treatment
Blacks and ethnic minorities are more likely to experience these issues
All of the above is true

Not recommended unless medical therapy is first initiated
The first line of treatment in the new JNC 8 recommendations for HTN
Blacks and ethnic minorities are more likely to engage in appropriate lifestyle modifications
Not likely to beneficial for HF management

Despite similar care patterns and treatment blacks had worse CAD outcomes
Less than 1% of Blacks were included
Blacks had similar great results as whites in the study hospitals for CAD outcomes
Not enough blacks were included to adequately interpret the results

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The online educational activity contains video and slides from the Internal Medicine Section Cardiology 1 Symposium held on August 4, 2014 during the National Medical Association’s 2014 Scientific Assembly in Honolulu, Hawaii. This activity was supported by educational grants from Boston Scientific and Arbor Pharmaceuticals.


Needs Assessment / Gap Analysis

There is a Heart Failure (HF) epidemic going on worldwide and nationally. It is one of the few cardiovascular disorders on the rise. According to the World Health Organization (WHO), there are over 23 million cases of HF worldwide and 6 million in the US alone.1,2 In the US, there are an estimated 670,000 new cases of HF diagnosed annually.3 This condition is a major cause of morbidity and mortality. It is the leading cause of hospitalizations of the elderly in the US. There are over 1 million hospitalizations annually and over 50% of these patients are readmitted within 6 months of discharge.4 Heart failure is the single largest expense for Medicare costing over $32 billion annually.5

It is well known that there is a difference in the epidemiology, clinical course and some treatment modalities in African Americans and Whites in the area of heart failure. For example,

Hypertension is the most frequent cause of heart failure in Blacks, whereas, Coronary Artery Disease is more often the underlying cause of heart failure in Whites.6 It is also accepted that heart failure occurs in Blacks at a younger age and have worse outcomes compared to Whites. In terms of therapy, it has been shown in earlier studies that Isosorbide dinitrate/ Hydrazine(iso/hyd) therapy when used in conjunction with the usual therapy for heart failure, resulted in better outcomes in Blacks than when these two drugs were not a part of the drug regimen for heart failure in Blacks. Newer studies with a reformulated Iso/Hyd have confirmed these findings.

In recent years, the ACC/AHA guidelines have added device therapy for the treatment of heart failure. Despite the risks of cardiovascular disease, including heart failure in African Americans, some guideline-indicated therapies are disproportionately underused in the Black population.

Heart failure studies have demonstrated that treatment guidelines are adopted slowly, are applied inconsistently, and as a result often fail to lead to improvements in patient care and outcomes. Re-hospitalization for heart failure remains a dismal and expensive problem in this country and especially for African Americans.

Thus, there is a demonstrated need for improved understanding and application of the principles involved in the diagnosis and management of heart failure in the African American and other Black populations.


Learning Objectives

Upon completion of this educational activity participants should be able to:

  1. Describe heart failure, the various stages of heart failure, and the epidemiology and incidence of the disorder;
  2. Recognize the disparities among African Americans and increase awareness of state-of-the-science and guideline recommendations for treatment and self-care of heart failure;
  3. Examine health care policy initiatives — specifically the Affordable Care Act and how this may impact heart failure care;
  4. Discuss the expense associated with HF hospitalizations and readmissions; and
  5. Identify how to improve Guideline-Directed Medical Therapies (GDMT).


Disclosures / Acknowledgement of Financial Support

In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all planners, teachers, and authors involved in the development of CME content are required to disclose any relevant financial relationships.  An individual has a relevant financial relationship if he or she (or spouse/partner) has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control.  As an accredited provider balance, independence, objectivity, and scientific rigor must be demonstrated in all educational activities.

The following faculty presenters have indicated relationships with commercial interests:

Icilma Fergus, MD
Dr. Fergus has been a consultant/advisor for St. Jude Medical, Inc. She has been a consultant for Arbor Pharmaceuticals.

Jerome A. Robinson, MD
Dr. Robinson has been on the speaker’s bureau for Arbor Pharmaceuticals, Astra Zeneca, Boehringer Ingelheim, Bristol Myers-Squibb, Daiichi Sankyo, Eli Lilly, Forest, GlaxoSmithKline, Merck Inc., Novartis, Sanofi Aventis and Takeda.


The following faculty presenters and planners/managers have stated that they do not have financial relationships or relationships to products or devices with any commercial interests related to the content of this activity during the past 12 months:

Robert Gillespie, MD

Wallace Johnson, MD

Colin Syphax

Jill Dutcher

Chanda Nicole Holsey, DrPH, MPH


This activity was supported by educational grants from Boston Scientific and Arbor Pharmaceuticals.


Continuing Education Credits

The National Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians

The National Medical Association designates this internet enduring activity for a maximum for 2 AMA PRA Category 1 Credits.  Physicians should claim credit commensurate with the extent of their participation in the activity.

Participants must achieve at least 80% correct in the post test evaluation to be awarded credit. 



December 8, 2015



The National Medical Association (NMA) and its staff and consultants, are not responsible for injury or illness resulting from the use of medications or modalities discussed during this educational activity. The NMA does not endorse the use of off-labeled medications. Speakers must identify off-labeled status of any pharmaceuticals mentioned in their lectures.


Icilma Fergus, M.D.

 Icilma Fergus, M.D. President
Association of Black Cardiologists
Associate Professor of Medicine
Director, Mount Sinai Heart Center for Cardiovascular Disparities
New York, NY
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Robert L. Gillespie, M.D.

Robert L. Gillespie, M.D. Chairman of the Board
Association of Black Cardiologists
Sharp Rees-Stealy Medical Group
Director, Nuclear Imaging
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Wallace Johnson, M.D.

Wallace Johnson, M.D. Chair, NMA Internal Medicine Section
Research Interests:
Hypertension and vascular biology.
Cardiovascular disease in special populations.
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Jerome Robinson, M.D.

Jerome Robinson, M.D. Assistant Professor (Cardiology)
University of California at San Diego
San Diego, CA
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Elijah Saunders, M.D.

Elijah Saunders, M.D. Professor of Medicine (Cardiology) Head, Section of Hypertension - University of Maryland School of Medicine Baltimore, MD
Co-Chair,Cardiology Section(Internal Medicine)
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