African Americans with HFpEF: An Insight to HRQOL and Frailty Based on Renal Function

Abstract

Background: African Americans (AA) are at a higher risk for heart failure with preserved ejection fraction (HFpEF) and renal impairment. HFpEF is associated with frailty and poor health-related quality of life (HRQOL). Renal impairment amplifies the inflammatory state in HFpEF, worsens ventricular function, and leads to increased frailty and poorer HRQOL. In HFpEF trials, AAs are often underrepresented and patients with renal impairments are often excluded. As such, little is known about HRQOL and frailty in AA with HFpEF. Objectives: To examine HRQOL scores and frailty in AA with HFpEF, and to explore the moderation effect of estimated glomerular filtration rate (eGFR) on the relationship between frailty and HRQOL. Methods: In this cross-sectional study, 16 AA with HFpEF were recruited from an outpatient heart failure clinic. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to measure HRQOL. Frailty was evaluated using Fried’s frailty criteria. eGFR was calculated according to CKD-EPI equation based on the latest creatinine level from the participants’ medical records. Diagnosis of Chronic Kidney Disease was obtained from participants’ medical records. Comorbidities were determined by the functional comorbidity index (FCI). Multiple regression and ordinal logistic regression were used, with robust standard error and Bayesian method. Data were analyzed using Stata software (version 16). Results: The sample consisted of 7 males and 9 females with a mean age of 56 ±7 years. They had 5±3 comorbid conditions and 3 had Chronic Kidney Disease. The mean eGFR was 62.25 ± 26 ml/min/1.73m2. The mean HRQOL score was 59 indicating poor HRQOL. There was 1 non-frail, 10 pre-frail, and 5 frail subjects. Sex and the comorbidity score explained 36.36 % of the variance in HRQOL (p=0.03). Females had worse HRQOL scores than males (coefficient= -15.81, p=0.04, CI = -31.49, -0.15). Frailty was not associated with age (p=0.27). eGFR was not a moderator of the relationship between frailty and HRQOL (p=0.06). Conclusion: African Americans with HFpEF had poor HRQOL. AA females and AA with higher numbers of comorbidities reported worse HRQOL. Most subjects were either pre-frail or frail indicating frailty may be an issue for AA with HFpEF.