Abstract
Individuals of South Asian descent have a high prevalence of comorbidities that are risk factors for the development of heart failure (HF), including diabetes mellitus and metabolic syndrome. However, little is known about the prevalence of HF, its management and prognosis for this population compared to Caucasians. Therefore, a literature review relating to the nature, outcome and treatment of HF in South Asian patients compared to Caucasians was conducted. It was anticipated that collating existing studies in this manner would be useful for guiding professionals in managing HF within this ethnic group, given that to achieve optimal care, regimens need to take into account cultural differences that may impact on adherence. Reviewed literature showed that South Asians with HF were more likely to be younger and have diabetes and hypertension. These papers also implied that outcomes for South Asians with HF were similar or even better than for Caucasians. The review highlighted the under-representation of South Asians in HF trials, meaning that evidence-based recommendations tailored to this specific population are limited. This is an important consideration because ethnic differences in response to medication have been reported; it cannot be assumed that treatments shown to work for Caucasians will be efficacious for those from minority ethnic groups.
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References
Cleland JGF, Khand A, Clark AC (2001) The heart failure epidemic: exactly how big is it? Eur Heart J 22:623–626
Jhund PS, McMurray JJ (2008) Heart failure after acute myocardial infarction: a lost battle in the war on heart failure? Circulation 118:2019–2021
Chiu M, Austin PC, Manuel DG, Tu JV (2010) Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007. CMAJ 182:E301–E307
Department of Health (2000) Coronary heart disease national service frameworks: modern standards and service models. Department of Health, London
Haviland M, Morales L, Dial T, Pincus H (2005) Race/ethnicity, socioeconomic status, and satisfaction with health care. Am J Med Quality 20:195–203
Mead N, Roland M (2009) Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices. BMJ 339:b3450
Lakhani M (2008) No patient left behind: how can we ensure world class primary care for black and minority ethnic people?. Department of Health, Leeds
Scarborough P, Bhatnagar P, Kaur A, Smolina K, Wickramasinghe K, Rayner M (2010) Ethnic differences in cardiovascular disease: 2010 edition. Department of Public Health: University of Oxford
Chauhan U, Baker D, Lester H, Edwards R (2010) Exploring uptake of cardiac rehabilitation in a minority ethnic population in England: a qualitative study. Eur J Cardiovasc Nurs 9:68–74
Cortes O, Arthur H (2006) Determinants of referral to cardiac rehabilitation programs in patients with CHD: a systematic review. Am Heart J 151:249–256
Tod AM, Wadsworth E, Asif S, Gerrish K (2001) Cardiac rehabilitation: the needs of South Asian cardiac patients. Br J Nurs 10:1028–1033
Szczepura A (2011) Nutrition in an ethnically diverse society: what are some of the key challenges? Proc Nutr Soc 70:252–262
Office for National Statistics. Population estimates by ethnic group 2002–2009. www.ons.gov.uk/ons/taxonomy/index.html?nscl=Population+Estimates+by+Ethnic+Group. Accessed 24 Feb 2012
Statistics Canada. Canadian Demographics at a Glance. www.statcan.gc.ca/pub/91-003-x/91-003-x2007001-eng.pdf. Accessed 24 Feb 2012
Bradby H (2003) Describing ethnicity in health research. Ethn Health 8:5–13
Gupta M, Singh N, Verma S (2006) South Asians and cardiovascular risk: what clinicians should know. Circulation 113:e924–e929
Blackledge HM, Newton J, Squire IB (2003) Prognosis for South Asian and white patients newly admitted to hospital with heart failure in the United Kingdom: historical cohort study. BMJ 327:526–531
Kaul P, McAlister FA, Ezekowitz JA, Grover VK, Quan H (2011) Ethnic differences in 1-year mortality among patients hospitalised with heart failure. Heart 97:1048–1053
Alexander M, Grumbach K, Remy L, Rowell R, Massie BM (1999) Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity. Am Heart J 137:919–927
Evangelista LS, Dracup K, Doering LV (2002) Racial differences in treatment-seeking delays among heart failure patients. J Card Fail 8:381–386
Lip GY, Barnett AH, Bradbury A, Cappuccio FP, Gill PS, Hughes E, Imray C, Jolly K, Patel K (2007) Ethnicity and cardiovascular disease: prevention in the United Kingdom: a practical approach to management. J Hum Hypertens 21:183–211
Fischbacher CM, Bhopal R, Povey C, Steiner M, Chalmers J, Mueller G, Jamieson J, Knowles D (2007) Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians. BMC Public Health 7:142
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW (2009) 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119:e391–e479
Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, Kelemen L, Yi C, Lonn E, Gerstein H, Hegele RA, McQueen M (2000) Differences in risk factors, atherosclerosis and cardiovascular disease between ethnic groups in Canada: The Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet 356:279–284
Barnett AH, Dixon AN, Bellary S, Hanif MW, O’Hare JP, Raymond NT, Kumar S (2006) Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia 49:2234–2246
Nichols GA, Gullion CM, Koro CE, Ephross SA, Brown JB (2004) The incidence of congestive heart failure in type 2 diabetes: an update. Diabetes Care 27:1879–1884
Chambers JC, Obeid OA, Refsum H, Ueland P, Hackett D, Hooper J, Turner RM, Thompson SG, Kooner JS (2000) Plasma homocysteine concentrations and risk of coronary heart disease in UK Indian Asian and European men. Lancet 355:523–527
Ramachandran A, Ma RC, Snehalatha C (2010) Diabetes in Asia. Lancet 375:408–418
Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti KG, Harland J, Patel S, Ahmad N, Turner C, Watson B, Kaur D, Kulkarni A, Laker M, Tavridou A (1999) Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi and European Origin populations: cross sectional study. BMJ 319:215–220
Mamas MA, Deaton C, Rutter MK, Yuille M, Williams SG, Ray SG, New J, Gibson JM, Neyses L (2010) Impaired glucose tolerance and insulin resistance in heart failure: underrecognized and undertreated? J Card Fail 16:761–768
Deaton C, Mamas MA, Rutter MK, Gibson M, Bowell S, Byrne R, Coezy K, Gow J, Williams S (2011) Glucose and insulin abnormalities in patients with heart failure. Eur J Cardiovasc Nurs 10:75–87
Shibata R, Ouchi N, Murohara T (2009) Adiponectin and cardiovascular disease. Circ J 73:608–614
Costacou T, Zgibor JC, Evans RW, Otvos J, Lopes-Virella MF, Tracy RP, Orchard TJ (2005) The prospective association between adiponectin and coronary artery disease among individuals with type 1 diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study. Diabetologica 48:41–48
Pischon T, Girman CJ, Rifai N, Hotamisligil GS, Rimm EB (2004) Plasma adiponectin levels and risk of myocardial infarction in men. JAMA 291:1730–1737
Schulze MB, Shai I, Rimm EB, Li T, Rifai N, Hu FB (2005) Adiponectin and future coronary heart disease events among men with type 2 diabetes. Diabetes 54:534–539
Retnakaran R, Hanley AJG, Zinman B (2006) Does hypoadiponectinmia explain the increased risk of diabetes and cardiovascular disease in South Asians? Diabetes Care 29:1950–1954
Raji A, Gerhard-Herman MD, Warren M, Silverman SG, Raptopoulos V, Mantzoros CS, Simonson DC (2004) Insulin resistance and vascular dysfunction in nondiabetic Asian Indians. J Clin Endocrinol Metab 89:3965–3972
McKeigue PM, Miller GJ, Marmot MG (1989) Coronary heart disease in South Asians overseas: a review. J Clin Epidemiol 42:597–609
Bhalodkar NC, Blum S, Rana T, Bhalodkar A, Kitchappa R, Kim KS, Enas E (2004) Comparison of levels of large and small high-density lipoprotein cholesterol in Asian Indian men compared with Caucasian men in the Framingham Offspring Study. Am J Cardiol 94:1561–1563
Kulkarni HR, Nanda NC, Segrest JP (1999) Increased prevalence of smaller and denser LDL particles in Asian Indians. Arterioscler Thromb Vasc Biol 19:2749–2755
Chambers JC, McGregor A, Jean-Marie J, Kooner JS (1999) Abnormalities of vascular endothelial function may contribute to increased coronary heart disease in UK Indian Asians. Heart 81:501–504
Shantsila E, Wrigley B, Shantsila A, Tapp LD, Blann AD, Gill PS, Lip GY (2011) Ethnic differences in macrovascular and microvascular function in systolic heart failure. Circ Heart Fail 4:754–762
Chaturvedi N (2003) Ethnic differences in cardiovascular disease. Heart 89:681–686
Feder G, Crook AM, Magee P, Banerjee S, Timmis AD, Hemingway H (2002) Ethnic differences in invasive management of coronary disease: prospective cohort study of patients undergoing angiography. BMJ 324:511–516
Chambers JC, Eda S, Bassett P, Karim Y, Thompson SG, Gallimore JR, Pepys MB, Kooner JS (2001) C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites. Circulation 104:145–150
Forouhi NG, Sattar N, McKeigue PM (2001) Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Int J Obes Relat Metab Disord 2:1327–1331
Chandalia M, Cabo-Chan AV Jr, Devaraj S, Jialal I, Grundy SM, Abate N (2003) Elevated plasma high-sensitivity C-reactive protein concentrations in Asian Indians living in the United States. J Clin Endocrinol Metab 88:3773–3776
Deaton C, Froelicher ES, Wu LH, Ho C, Shishani K, Jaarsma T (2011) The global burden of cardiovascular disease. Eur J Card Dis 10(Suppl 2):S5–S13
Huffman MD, Prabhakaran D (2010) Heart failure: epidemiology and prevention in India. Natl Med J India 23:283–288
Bainey KR, Jugdutt BI (2009) Increased burden of coronary artery disease in South-Asians living in North America: need for an aggressive management algorithm. Atherosclerosis 204:10
Patel JV, Vyas A, Cruickshank JK, Prabhakaran D, Hughes E, Reddy KS, Mackness MI, Bhatnegar D, Durrington PN (2006) Impact of migration on coronary heart disease risk factors: comparison of Gujaratis in Britain and their contemporaries in villages of origin in India. Atherosclerosis 185:297–306
Lip G, Zarifis J, Beevers DG (1997) Acute admissions with heart failure to a district general hospital serving a multiracial population. Int J Clin Pract 51:223–227
Gill PS, Calvert M, Davis R, Davies MK, Freemantle N, Lip GYH (2011) Prevalence of heart failure and atrial fibrillation in minority ethnic subjects: The Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). PLoS ONE 6:e26710
Davies MK, Hobbs FDR, Davis RC, Kenkre JE, Roalfe AK, Hare R, Wosornu D, Lancashire RJ (2001) Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study. Lancet 358:439–444
Sosin MD, Bhatia GS, Zarifis J, Davis RC, Lip GYH (2004) An 8-year follow-up study of acute admissions with heart failure in a multiethnic population. Eur J Heart Fail 6:669–672
Newton JD, Blackledge HM, Squire IB (2005) Ethnicity and variation in prognosis for patients newly hospitalised for heart failure: a matched historical cohort study. Heart 91:1545–1550
Singh N, Gupta M (2005) Clinical characteristics of South Asian patients hospitalized with heart failure. Ethn Dis 15:615–619
Patel JV, Sosin M, Lim HS, Chung I, Panja N, Davis RC, Hughes EA, Lip GY (2007) Raised leptin concentrations among South Asian patients with chronic heart failure. Int J Cardiol 122:34–40
Sosin MD, Patel JV, Bhatia GS, Hughes EA, Davis RC, Lip GY (2008) Effects of white Europeans, African Caribbean and South Asian ethnicity on homocysteine levels in patients with systolic heart failure. Int J Cardiol 129:69–75
Sosin MD, Bhatia GS, Lip GYH, Davis RC (2004) Drug development and the importance of ethnicity: lessons from heart failure management and implications for hypertension. Curr Pharm Des 10:3569–3577
Lip GY, Rathore VS, Katira R, Watson RD, Singh SP (1999) Do Indo-Asians have smaller coronary arteries? Postgrad Med J 75:463–466
Banerjee AT, Gupta M, Singh N (2007) Patient characteristics, compliance, and exercise outcomes of South Asians enrolled in cardiac rehabilitation. J Cardiopulm Rehabil Prev 27:212–218
Rotter JB (1954) Social learning and clinical psychology. Prentice-Hall, New York
Carney R, Fitzsimons D, Dempster M (2002) Why people experiencing acute myocardial infarction delay seeking medical assistance. Eur J Cardiovasc Nurs 1:237–242
Lip GY, Khan H, Bhatnagar A, Brahmabhatt N, Crook P, Davies MK (2004) Ethnic differences in patient perceptions of heart failure and treatment: the West Birmingham heart failure project. Heart 90:1016–1019
Mathur R, Hull SA, Badrick E, Robson J (2011) Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management. Br J Gen Pract 61:e262–e270
Galasko GIW, Senior R, Lahiri A (2005) Ethnic differences in the prevalence and aetiology of left ventricular systolic dysfunction in the community: the Harrow heart failure watch. Heart 91:595–600
Galdas PM, Ratner PA, Oliffe JL (2012) A narrative review of South Asian patients’ experiences of cardiac rehabilitation. J Clin Nurs 21:149–159
Darr A, Astin F, Atkin K (2008) Causal attributions, lifestyle change, and coronary heart disease: illness beliefs of patients of South Asian and European origin living in the United Kingdom. Heart Lung 37:91–104
Farooqi A, Nagra D, Edgar T, Khunti K (2000) Attitudes to lifestyle risk factors for coronary heart disease amongst South Asians in Leicester: a focus group study. Fam Pract 17:293–297
Lawton J, Ahmad N, Hanna L, Douglas M, Bains H, Hallowell N (2008) ‘We should change ourselves, but we can’t’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes. Ethn Health 13:305–319
Heiat A, Gross CP, Krumholz HM (2002) Representation of the elderly, women and minorities in heart failure clinical trials. Arch Intern Med 162:1682–1688
Schnittker J, Bhatt M (2008) The role of income and race/ethnicity in experiences with medical care in the United States and United Kingdom. Int J Health Serv 38:671–695
Taira DA, Safran DG, Seto TB, Rogers WH, Inui TS, Montgomery J, Tarlov AR (2001) Do patient assessments of care differ by patient ethnicity? Health Serv Res 36:1059–1071
Brookes N, Magee P, Bhatti G (2000) Asian patients’ perspective on the communication facilities provided in a large inner city hospital. J Clin Nurs 9:706–712
Astin F, Atkin K, Darr A (2008) Family support and cardiac rehabilitation: a comparative study of the experiences of South Asian and White-European patients and their carer’s living in the United Kingdom. Eur J Cardiovasc Nurs 7:43–51
Vasquez C, Javier RA (1991) The problem with interpreters: communicating with Spanish-speaking patients. Am J Psychiatry 136:171–174
Bhopal R (2000) What is the risk of coronary heart disease in South Asians? A review of UK research. J Public Health Med 22:375–385
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The authors acknowledge the support of The Greater Manchester Collaboration for Leadership in Applied Health Research and Care (CLAHRC), the Manchester Academic Health Sciences Centre and the Central Manchester Foundation Trust Biomedical Research Centre.
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Tierney, S., Deaton, C. & Mamas, M. Heart failure among South Asians: a narrative review of risk, nature, outcomes and management. Heart Fail Rev 18, 197–206 (2013). https://doi.org/10.1007/s10741-012-9319-x
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DOI: https://doi.org/10.1007/s10741-012-9319-x