Abstract 18644: Disparities in Inpatients’ Perceptions, Evaluation, and Responses to Worsening Heart Failure Symptoms- Racial and Financial Status

Abstract

Background: Most patients with heart failure (HF) exhibit a broad symptom profile, sporadically marked by periods of acute exacerbation and readmission that can be prevented by symptom monitoring and adequate self-care. Yet, patients are frequently unable to adhere to appropriate self-care measures. Reasons for non-adherence are multifactorial including disparities related to race and financial status, and are insufficiently investigated. Thus, a secondary analysis study was conducted to 1) compare HF inpatients’ knowledge, cognitive function and HF self-care based on their race (Black and White), and financial status (higher if they reported having “enough or more than enough to make ends meet” and lower if they “did not have enough to make ends meet”), and 2) investigate disparities in patients’ perception and evaluation of symptoms, and actions taken during HF exacerbation based on their race and financial status. Methods: A total of 185 patients (62 years ±13, 49 % female, 76% white) admitted for acute HF exacerbation completed standardized instruments measuring cognitive function, HF knowledge, HF self-care, perception of, and responses to HF symptoms. Chi-square and independent samples t-test analyses were used. Results: Black patient with HF had lower levels of HF knowledge, cognitive function, and engagement in self-care maintenance behaviors than White patients (p <.05). Black patients believed medication nonadherence, excessive fluid intake, hypertension, and overeating were causes of their worsening symptoms (p <.05). Black patients tended to call an ambulance in response to worsening symptoms while White patients took their water pill (p = 0.03). Patients with lower financial status reported higher body mass index than those with higher financial status (p = .03). Patients with lower financial status linked their symptoms to depression and lung problems (p =.02), but they did nothing to manage symptoms and hoped their symptoms would go away (p < .05). Conclusions: Interventions that take into account culture and financial status are needed to mitigate racial disparities, improve symptom perception, and promote appropriate responses in HF patients.