Health Status Disparities by Sex, Race/Ethnicity, and Socioeconomic Status in Outpatients With Heart Failure

OBJECTIVES This study sought to describe the health status of outpatients with heart failure and reduced ejection fraction (HFrEF) by sex, race/ethnicity, and socioeconomic status (SES). BACKGROUND Although a primary goal in treating patients with HFrEF is to optimize health status, whether dispanties by sex, race/ethnicity, and SES exist is unknown. METHODS In the CHAMP-HF (Change the Management of Patients with Heart Failure) registry, the associations among sex, race, and SES and health status, as measured by the Kansas City Cardiomyopathy Questionnaire-overall summary (KCCQ-os) score (range 0 to 100; higher scores indicate better health status) was compared among 3,494 patients from 140 U.S. clinics. SES was categorized by total household income. Hierarchical multivariate linear regression estimated differences in KCCQ-os score after adjusting for 31 patient characteristics and 10 medications. RESULTS Overall mean KCCQ-os scores were 64.2 +/- 24.0 but lower for women (29% of sample; 60.3 +/- 24.0 vs. 65.9 +/- 24.0, respectively; p < 0.001), for blacks (60.5 +/- 25.0 vs. 64.9 +/- 23.0, respectively; p < 0.001), for Hispanics (59.1 +/- 21.0 vs. 64.9 +/- 23.0, respectively; p < 0.001), and for those with the lowest income (<$25,00 0; mean; 57.1 vs. 63.1 to 74.7 for other income categories; p < 0.001). Fully adjusted KCCQ-os scores were 2.2 points tower for women (95% confidence interval [CI]; -3.8 to -0.6; p = 0.007), no different for blacks (p = 0.74), 4.0 points tower for Hispanics (95% CI: -6.6 to -1.3; p = 0.003), and lowest in the poorest patients (4.7 points lower than those with the highest income (95% CI: 0.1 to 9.2; p = 0.045; p for trend = 0.003). CONCLUSIONS Among outpatients with HFrEF, women, blacks, Hispanics, and poorer patients had worse health status, which remained significant for women, Hispanics, and poorer patients in fully adjusted analyses. This suggests an opportunity to further optimize treatment to reduce these observed disparities. (J Am Coll Cardiol HF 2018;6:465-73) (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).