OR1. Frailty, Quality of Life, and Renal Dysfunction in African Americans with Preserved Ejection Fraction Heart Failure

Abstract

<h3>Background</h3> African Americans (AA) are at a higher risk for heart failure with preserved ejection fraction (HFpEF) and renal impairment. They are predisposed to several shared risk factors for both syndromes at a younger age. 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. <h3>Objectives</h3> We aimed 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. <h3>Methods</h3> This was a cross-sectional study. Sixteen AA with HFpEF were recruited between September 2019 and March 2020 from an outpatient heart failure clinic in Chicago. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to measure HRQOL. Frailty was evaluated using Fried's frailty criteria, which included assessment of unintentional weight loss, weakness (hand-held dynamometer), slowness (walking speed), physical activity (Minnesota Leisure Time Activity questionnaire), and exhaustion (2 questions from Center for Epidemiological Studies Depression scale). Subjects meeting 3 or more criteria were classified as frail, 1 to 2 criteria were classified as pre-frail, and 0 criterion were classified as non-frail. eGFR was calculated according to CKD-EPI equation based on the latest creatinine levels 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) with the significance value set at p-value ≤ 0.05. <h3>Results</h3> 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 calculated 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 a predictor for HRQOL (p=0.03), but it was not a moderator of the relationship between frailty and HRQOL (p=0.06). <h3>Conclusion</h3> In this sample, 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. eGFR may be a clinically useful marker for early detection of poor HRQOL in this population.