Costs and Quality of Care: Disparities in Heart Failure Diagnosis and Care

Abstract Heart failure (HF) remains a major public health challenge in the United States, affecting millions of adults and imposing a substantial clinical and economic burden. Although advances in pharmacologic, device-based, and advanced HF therapies have improved care, these benefits have not been distributed equitably. Persistent disparities in diagnosis, treatment, and outcomes continue to affect vulnerable populations and contribute to excess morbidity, mortality, hospitalizations, and healthcare costs. This review examines the major drivers of disparities in HF diagnosis and care, summarizes their impact on outcomes and healthcare utilization, and highlights emerging strategies to advance more equitable HF care. This narrative review synthesizes contemporary evidence on disparities in HF care and outcomes, with emphasis on differences related to sex, race and ethnicity, geographic location, health literacy, and social determinants of health. It also reviews emerging innovations in care delivery, digital health, artificial intelligence, and policy that may help reduce inequities. The literature shows that disparities in HF are shaped largely by modifiable social, structural, and system-level factors rather than biology alone. Women and racial and ethnic minority populations are less likely to receive guideline-directed medical therapy and advanced HF services, while patients in rural settings often face reduced access to specialty care and disease-modifying therapies. Limited health literacy and adverse social determinants further increase treatment burden, impair self-management, and worsen outcomes. Emerging approaches, including telehealth, remote monitoring, AI-enabled risk stratification, community-engaged care models, and equity-focused policy reform, offer promising pathways to narrow these gaps. Disparities in HF care continue to worsen outcomes and increase avoidable costs. Reducing these gaps will require equitable delivery of evidence-based therapies, improved access and health literacy, and attention to the social determinants shaping care. Equity-centered innovation and health system design are essential to achieving high-value HF care for all.