Heart failure is the number one cause of death in the country, contributing to approximately 287,000 deaths a year. It’s a condition that occurs when the heart can’t pump enough blood to meet the body’s needs.
Dr. Alanna A. Morris is an associate professor in the cardiology division at Emory University’s School of Medicine. From her experience as a cardiologist, Morris has seen the many different ways that a person can develop heart disease.
“It could happen as a result of a heart attack; it can happen as a result of a family history; it can happen from drug use. There’s all sorts of causes,” Morris said. “But at the end of the day, what happens is the heart is not able to meet the metabolic needs of the body. And so because of that, patients feel short of breath. They feel very fatigued. Fluid often accumulates in their legs or their bellies. They have difficulty sleeping, and they just aren’t able to carry on sometimes [with the] normal activities of daily living.”
According to the Centers for Disease Control and Prevention (CDC), there are certain medical conditions that can increase one’s risk for heart disease, such as coronary artery disease, diabetes, high blood pressure and obesity. Unhealthy behaviors like smoking tobacco, not getting enough physical activity and eating fatty, sodium rich foods can also raise the likelihood of heart disease.
Over six million Americans are currently living with heart failure. Although heart failure affects people of all ages, genders and races, it doesn’t do so evenly. This health condition is more common in Black Americans and adults over the age of 65.
When she’s not caring for patients, Morris is also an avid researcher, whose interests include investigating race and gender as a catalyst for the health disparities in heart failure and cardiovascular disease. One of her papers, featured in the American Heart Association (AHA) Journal, states that “African Americans’ rates of death are 2.6 and 2.97-fold higher, respectively, than White men and women. Similarly, the rate of heart failure hospitalization for African American men and women is nearly 2.5-fold higher” when compared with white Americans.
While the relative rate of heart failure hospitalization has improved for other racial minorities, the disparity between Black and white patients has not decreased during the last decade. Researchers have used access to care and socioeconomic status as traditional explanations for racial disparities in heart failure outcomes, although contemporary data suggests that factors like genetic susceptibility and implicit bias may play a larger role.
“Black and Latina women tend to develop heart failure and heart disease about 10 years earlier as compared to their white counterparts,” Morris said. “So, we tend to see these health disparities…affect Black and Latino communities at a higher rate.”
In Morris’ opinion, to begin understanding why minority women have heart failure earlier, one must first better understand structural racism and the social determinants of health, which are the conditions in the environments where people work and live, and how these factors impact their health and quality of life.
Despite having a higher body mass index (BMI) on average, Black women are less likely to attempt weight loss than White women. Morris’ research implies that weight perceptions vary by race due to cultural differences in ideal body image and that hair maintenance may be a unique barrier to physical activity for Black women in particular.
Living in more impoverished areas or in food deserts is also associated with an increased risk of heart failure.
“We know that this country was sort of designed and founded in a way that kept people of color in communities that lacked resources that had more pollution, [and] had less access to what I call the ability to promote health,” Morris said. “And because of that, we see that these risk factors like high blood pressure, diabetes, [and] obesity tend to be more prevalent in communities of color. I think for women of color, there are other factors that are extremely important, including what we call the gender determinants of health. So for example, women often sort of bear the burden of taking care of children and other dependents and loved ones who may fall sick with illness. Because of that, women often don’t take care of themselves.”
Tannie Coward was diagnosed with congestive heart failure seven years ago. She initially believed that she had an upper respiratory infection, and went to urgent care before being sent to a larger hospital.
“It’s been an up and down journey,” Coward says. “I have good days, and I have bad days. For the first couple of years, it was pretty overwhelming, to say the least. Upon my initial diagnosis, I was told that I needed to quit my job, my career that I had for 33 years. And I also had to shut down my business as a wedding and event planner. So this was definitely life changing for me.”
The idea that worked best for Coward was making lifestyle changes. After learning that she had heart failure, she began to exercise more, and she changed her diet. She recommends that individuals diagnosed with heart failure find support groups that can assist those living with the difficult condition.
“It’s important that women with heart failure, especially Black women, have the right support network in place to help us feel our best,” Coward said. “We’re always taught to be strong, and that we can surpass anything, but it’s important that we understand that our support can come from family, friends, doctors, advocacy groups- anything that helps us feel our best. And to me, it’s just important that women of color understand that we too need help. We too need support, and there are places that we can get that support from.”
Morris has joined an initiative called Hear Your Heart, to empower women living with heart failure to take control of their health.
“This type of campaign, that really speaks directly to patients, is something that’s really important to me because it…intertwines very much with the clinical practice that I participate in, as well as the research that I’m focused on, which is really trying to improve outcomes for patients of color, women of color,” Morris said.
Morris hopes to help more women feel confident educating themselves, asking questions and advocating for their health. Hear Your Heart’s website has free resources and videos for anyone who is interested in improved heart health.
In terms of protecting oneself from developing heart failure in the first place, Morris believes prevention is key. She describes the best thing that women can do for themselves is to modify their lifestyle. Morris advocates for staying physically active, and eating diets that are high in fruits and vegetables. She further advises against consuming large amounts of sodium and animal proteins.