Abstract 14636: Social Determinants of Health and Clinical Outcomes in a Diverse Hypertrophic Cardiomyopathy Cohort

Abstract

Introduction: Contemporary studies are needed to evaluate impact of social determinants of health (SDH) and clinical outcomes in diverse hypertrophic cardiomyopathy (HCM) populations. Hypothesis: Among predominant Black/Hispanic minority population, HCM-related death is higher than reported literature and may be related to SDH. Methods: Data from HCM patients were obtained in a large academic safety-net hospital from 2017 to 2022. Outcomes including heart failure (HF), atrial fibrillation, stroke, ventricular arrhythmias, septal reduction therapy (SRT) and death were obtained by chart review. Zip codes were extracted using the SDH database from the Neighborhood Atlas from University of Wisconsin to determine area deprivation index (ADI 1-10, higher ADI signifies greater neighborhood disadvantage). Chi-square and binary logistic regression analyses were conducted to assess association between ADI and outcomes, adjusting for demographic data. Results: At baseline, 118 HCM patients, were 52 ± 15 years old, 44% female, 54% Black, 20% Hispanic, 10% White, BMI 31± 6 kg/m2, and ESC score 2.4 ± 1.9. Seventy-eight (82%) patients had nonobstructive HCM (22 % apical variant) with maximal wall thickness of 19 ± 6 mm; 14% had late gadolinium enhancement (LGE) > 15%. Among 50% patients with genetic testing, 31% had a pathogenic/likely pathogenic sarcomere variant and 44% had variants of unknown significance. Over 6.3 years follow up (IQR 6.6), 20% patients developed incident HF, 19% AF, 8% SRT, and 6 (5%) patients suffered HCM-related death. Among the 23% of patients who had an ICD placed, 15% had appropriate ICD shock over 7 ± 7 years. Among the 105 patients with available zip codes, 44% patients had ADI > 6. There was no association between ADI and global outcome (OR [95% CI] = 1.32 [0.6-2.9], p = 0.49) or HCM-related death (OR [95% CI] = 0.46 [0.7-2.9], p = 0.41). Conclusions: Compared to published literature, our cohort was mainly Black/Hispanic with high degree of apical remodeling and low frequency of obstruction, highlighting need for focused efforts to improve HCM diagnosis in this population. Further, global outcome and HCM-related death were not related to zip-code level SDH. Larger diverse cohorts are needed to include individual level SDH in relation to outcomes.