Abstract 17555: Healthcare Disparities in Heart Failure

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Abstract

Introduction: Preclinical diastolic dysfunction (PDD, Stage B HF) is common in type 2 diabetes (DM2) and portends high risk for development of symptomatic HF (Stage C and D) in prior research in Caucasian cohorts. Routine screening for Stage B HF is not part of current consensus guidelines for DM2 management. The true prevalence and clinical characteristics of PDD in Hispanic populations with DM2 remain undefined.

Objective: To identify the prevalence and predictors of undetected PDD in a cohort of adult Hispanic patients with DM2.

Methods: From 2013 to 2016, a cross-sectional cohort study of consecutive adults with DM2 was performed in Pomona, California, USA. Patients without signs/symptoms of HF underwent 2D and Doppler echocardiographic screening, and were grouped into two subcohorts: 1) normal diastolic function, and 2) PDD, defined by either medial E/e’ ≥15 or left atrial volume index ≥ 34 mL/m2. Multivariable logistic analysis was performed.

Results: Among the 387 study subjects, 77% were Hispanic and mean age was 54.4±12.9 years. The prevalence of PDD was 37.5%. Those with PDD were older (mean 59 vs 51 years, p<0.01); more likely female (66 vs 53%, p=0.015); and had more cardiovascular comorbidities, including coronary artery disease (14 vs 4%, p<0.01) and hypertension (86 vs 68%, p<0.01). LV mass in the PDD group was also greater (118 vs 96 g/m2, p<0.01). Using multivariable logistic analysis, several significant predictors of PDD in adults with DM2 were identified: older age (adjusted OR (AOR) 1.31 [1.18, 1.46]); female gender (AOR 1.72 [1.06, 2.81]); overweight (AOR 3 [1.04, 8.64]) and obesity (AOR 3.86 [1.42, 10.48]); and the presence of at least Stage 3 CKD (AOR 4.9 [2.38, 10.1]).

Conclusions: Disparities remain in understanding racial and ethnic differences among patients with heart failure. PDD (stage B HF) was found in 37.5% of our predominantly Hispanic cohort with DM2. PDD predictors include older age, female gender, overweight, obesity, and Stage 3 or worse CKD. These findings suggest populations with similar ethnic, racial, and clinical features should be screened for PDD and Stage B HF. Further research is needed to better identify those at risk for progression to Stages C/D HF and whether early intervention would result in improved outcomes.

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