Afro-Caribbean Heart Failure in the United Kingdom

Abstract

Background— It has been reported that subjects of African descent present with heart failure at a younger age and because of different causes than whites. We present contemporary data from UK Afro-Caribbean patients in London. Methods and Results— All patients with heart failure presenting to St George’s Hospital Heart Failure clinic between 2005 and 2012 were included (n=1392). Patients were predominantly white (71%) and male (67%), and median age at presentation was 73 years (range, 18–100 years). In 211 Afro-Caribbean patients, the most common cause of heart failure was nonischemic dilated cardiomyopathy in 27.5% (whites, 19.9%; P <0.001). Lower rates of ischemic cardiomyopathy were observed (13% versus 41%; P <0.001). The fourth most common cause of heart failure in Afro-Caribbeans was cardiac amyloidosis (11.4%). The prevalence may have been even higher as not all patients were tested for amyloidosis. Patients with ATTR V122I had the worst prognosis compared with other causes of Afro-Caribbean heart failure and white patients. To better understand this condition, we analyzed data from the largest international cohort of ATTR V122I patients, followed up at the UK National Amyloidosis Center (n=72). Patients presented with cardiac failure (median age, 75 [range, 59–90] years). Median survival was 2.6 years from diagnosis. Conclusions— In London, the cause of heart failure varies depending on ethnicity and affects age of presentation and outcomes. In Afro-Caribbean patients, ATTR V122I is an underappreciated cause of heart failure, and cardiomyopathy is often misattributed to hypertension. As promising TTR therapies are in development, increased awareness and proactive detection are needed.

Prevalence of mutant ATTR cardiac amyloidosis in elderly African Americans with heart failure

“…Our observed prevalence is slightly higher than the background US population. We also note that our observed prevalence is lower than that of the Afro-Caribbean UK experience [5]-- a discrepancy likely due to differences in the genetic backgrounds of the two different countries.…”

Inflammatory and Molecular Pathways in Heart Failure—Ischemia, HFpEF and Transthyretin Cardiac Amyloidosis

“…However, according to current scientific knowledge its prevalence and medical implications are far greater than assumed. In patients of African descent in the UK and USA it is estimated to be the fourth most common cause of congestive heart failure [136,137]. Furthermore, autopsy samples revealed a prevalence of transthyretin amyloidosis of 10%–25% in the elderly (age >80 years) [138], proving ATTR is clearly underdiagnosed [134].…”

Heart Failure Hospitalizations and Risk Factors among the Multi-Ethnic Population from a Middle Income Country: The Suriname Heart Failure Studies

“…10 , 11 Various authors have suggested that the role social determinants of health, such as environment, lifestyle, access to care as well as comorbidities, play in the outcomes between different ethnicities must be taken into account. 11 , 12 , 13 , 14…”