Racial/Ethnic Disparities in Heart Failure: A cross-cohort collaboration

Heart failure (HF) is a growing health concern in the United States, associated with poor quality of life, frequent hospitalizations, high costs, and poor prognosis, with a 50% mortality rate at 5 years for both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). In most epidemiologic studies, health disparities have been noted in both incidence and prognosis related to HF overall and its subtypes, although statistical power has often been limited. We propose to pool data from 11 large longitudinal cohort studies, including MESA, to examine health disparities in the incidence and prognosis of HF and its subtypes in the United States. We aim to (1) assess race, sex, and age differences in incident HF, HFpEF, and HFrEF and all-cause mortality following diagnosis using Cox proportional hazards regression models in this exceptionally large multi-ethnic pooled cohort, and (2) quantify how hypothetical interventions on lifestyle factors potentially reduce these health disparities using inverse probability weighted marginal structural models (IPW MSM). This will allow an unprecedented opportunity for the identification of potential sources of variation in HF and its prognosis according not just to traditional clinical factors, but also to lifestyle and demographic factors often underpowered for analysis in single epidemiologic studies. This information could critically inform development and evaluation of targeted interventions to reduce the risk of HF in the community among susceptible subgroups, and therefore assist in mitigating health disparities in HF.