Abstract P308: Lower Neighborhood Socioeconomic Status is Associated with Higher BNP and Prolonged QTc Intervals among Heart Failure Patients with Preserved Ejection Fraction

Abstract

Background: Prior studies have shown that high B-type natriuretic peptide (BNP) levels and prolonged QTc intervals are associated with increased mortality, particularly sudden cardiac death, among heart failure (HF) patients. Whether neighborhood socioeconomic status (nSES) impacts BNP or QTc remains unknown. Methods: This study included consecutive patients enrolled from the outpatient clinic of the Northwestern Heart Failure with Preserved Ejection Fraction (HFpEF) Program from June 2007 to November 2010 after hospitalization for HF and followed through May 2011. Patients’ residential addresses were geocoded to identify their census tract of residence. Census 2000 data were used to create a single, summary score of nSES based on residential income, education and employment for each census tract and was divided into tertiles. Outcomes included post-discharge BNP and QTc, obtained within 1 month after HF hospitalization during the outpatient HFpEF clinic visit GEE models were used to examine the association between nSES and BNP and QTc adjusting for age, race, gender, NYHA class, blood pressure, obesity, smoking, glucose, eGFR, and comorbidities. Results: Among the 368 HFpEF patients, 37.0% were female, 50.5% White, avg. age was 64.8 yrs and 45.9% had NYHA class 3+. Higher nSES was significantly associated with lower BNP levels and shorter QTc intervals (Table). The adjusted BNP levels per nSES tertile were 718 pg/mL (±101.4) for the lowest nSES tertile, 508 pg/mL (± 75.3) for the intermediate nSES tertile and 454.2 pg/mL for the highest nSES tertile. Simlarly, QTc interval decreased with increasing tertile of nSES from 464.1 ms (± 5.7) in the lowest nSES tertile to 457.2 ms (± 5.8) and 448.9 ms (± 5.4) for the intermediate and highest tertiles, respectively. Conclusion: Low nSES is associated with increased BNP levels and a longer QTc interval in HFpEF patients. These findings may explain the association of nSES with higher rates of sudden cardiac death and worse outcomes among HF patients in disadvantaged neighborhoods.