Author + information
- Received November 14, 2017
- Revision received January 26, 2018
- Accepted February 6, 2018
- Published online May 28, 2018.
- Yevgeniy Khariton, MDa,
- Michael E. Nassif, MDb,
- Laine Thomas, PhDc,
- Gregg C. Fonarow, MDd,
- Xiaojuan Mi, PhDc,
- Adam D. DeVore, MD, MHSc,e,
- Carol Duffy, DOf,
- Puza P. Sharma, MBBS, MPH, PhDf,
- Nancy M. Albert, PhDg,
- J. Herbert Patterson, PharmDh,
- Javed Butler, MD, MPHi,
- Adrian F. Hernandez, MD, MHSc,e,
- Fredonia B. Williams, EdDj,
- Kevin McCague, MAf and
- John A. Spertus, MD, MPHa,∗ ()
- aCardiovascular Outcomes Research, University of Missouri-Kansas City, Saint-Luke's Mid-America Heart Institute, Kansas City, Missouri
- bDivision of Cardiology, Washington University School of Medicine in Saint Louis, Barnes-Jewish Hospital, Saint Louis, Missouri
- cDuke Department of Biostatistics and Informatics, Duke Clinical Research Institute, Durham, North Carolina
- dDivision of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California
- eDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina
- fNovartis Pharmaceuticals Corp., East Hanover, New Jersey
- gOffice of Nursing Research and Innovation, Cleveland Clinic School of Medicine, Cleveland Clinic Kaufman Center for Heart Failure, Cleveland, Ohio
- hDivision of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina Hospitals, Chapel Hill, North Carolina
- iDivision of Cardiovascular Medicine, Stony Brook School of Medicine, Stony Brook, New York
- jMended Hearts Organization Chapter 260, Huntsville, Alabama
- ↵∗Address for correspondence:
Dr. John A. Spertus, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, Kansas City, Missouri 64111.
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 disparities 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 (<$25,000; 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 lower for women (95% confidence interval [CI]: −3.8 to −0.6; p = 0.007), no different for blacks (p = 0.74), 4.0 points lower 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.
The CHAMP-HF registry was funded by the Novartis Pharmaceuticals Corp. Drs. Khariton and Nassif are supported by National Heart, Lung, and Blood Institute of Health Under Aware grant T32HL110837. Dr. Spertus has received funding from National Institutes of Health (NIH), Patient-Centered Outcomes Research Institute (PCORI), and Abbott Vascular; and is a consultant for United Healthcare, V-wave, Corvia, Janssen, AstraZeneca, Novartis, Amgen, and Bayer AG Pharmaceuticals Co.; and holds intellectual property rights for the Kansas City Cardiomyopathy Questionnaire and equity interest in Health Outcomes Sciences. Dr. Thomas has received funding from Novartis Pharmaceuticals Corp. Dr. Fonarow has received research support from NIH; and is a consultant for Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical; and has served on the Get With the Guidelines steering committee. Dr. DeVore has received research support from American Heart Association, Amgen, NIH, and Novartis; and is a consultant for Novartis. Dr. Hernandez has received research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck Sharpe and Dohme, and Novartis; and has received honoraria from Bayer AG, Boston Scientific, and Novartis. Dr. Butler has received research support from NIH, PCORI, and European Union; and is a consultant for Amgen, Array, AstraZeneca, Bayer AG, Boehringer Ingelheim, Bristol Myers-Squib, CVRx, G3 Pharmaceutical, Innolife, Janssen, Luitpold, Medtronic, Merck Sharpe and Dohme, Novartis, Relypsa, StealthPeptide, SC Pharma, Vifor, and ZS Pharma. Dr. Patterson has received research funding from Amgen, Bristol-Myers Squibb, Merck Sharpe and Dohme, and Novartis; and is a consultant for Amgen and Novartis. Drs. Sharma, McCague, and Duffy are employees of Novartis Pharmaceuticals Corp. Dr. Albert is a consultant for Novartis Pharmaceuticals Corp. The content of this paper is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 14, 2017.
- Revision received January 26, 2018.
- Accepted February 6, 2018.
- 2018 The Authors