SPC365

Socioeconomic and Ethnic Factors Affecting Heart Failure Treatment and Prognosis: Exploring Disparities in Clinical Outcomes

Session: SESSÃO DE COMUNICAÇÕES ORAIS 03 - EPIDEMIOLOGIA E ORGANIZAÇÃO DE CUIDADOS DE SAÚDE
Speaker: Rita Figueiredo

Congress: CPC 2025
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Rita M. Figueiredo; Ana Abrantes; João Fernandes Pedro; Fátima Salazar; Ana Francês; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; Fausto J. Pinto; Dulce Brito; João R. Agostinho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: Heart failure (HF) with reduced ejection fraction (rEF) is a prevalent and burdensome condition, with treatment shaped by social determinants such as ethnicity, migration status, and socioeconomic factors. However, little is known about disparities in treatment access between Portuguese and non-Portuguese patients and their impact on disease outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: This study aims to explore potential differences in the management of heart failure with reduced ejection fraction, including access to medication and survival outcomes between Portuguese and non-Portuguese patients.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: A prospective, single-center study was conducted involving HFrEF patients treated in a HF Clinic with a protocol-based follow-up program. The sample was divided into two groups: Portuguese and non-Portuguese, based on their ethnic origin. Treatment strategies, including the use of guideline-directed medical therapies (GDMT) and HF-related events were analyzed and compared. T-test for independent samples and Kaplan-Meier analysis were used.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: A total of 181 Portuguese patients were included [mean age: 66&plusmn;13 years; baseline left ventricle ejection fraction (LVEF): 29&plusmn;8%; follow-up LVEF: 44&plusmn;11%; ischemic heart disease: 50%] and 38 patients of African/Asian origin (age: 57&plusmn;16 years; baseline LVEF: 26&plusmn;8%; follow-up LVEF: 41&plusmn;13%; ischemic heart disease: 31%). The mean follow up was 2.4 years. No significant differences were found between the two groups in clinical, epidemiological or treatment characteristics, except for the use of sacubitril-valsartan (ARNI), which was significantly higher in Portuguese patients (p=0.033). Among the African/Asian group, 17 (44.7%) were not treated with ARNI, mainly due to an inability to afford the drug (11 patients; 28.9%). In the Portuguese group, 28 patients (15.5%) were not under ARNI and no one stated inability to afford the drug.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Prognostic analysis, adjusted for age, LVEF and NYHA class revealed that African/Asian patients had a significantly higher risk of HF events (cardiovascular death or HF-related hospitalization) compared to Portuguese patients, with a hazard ratio of 3.53 (95% CI 1.53&ndash;8.14; p=0.003) &ndash; Figure 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusions</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: This study reveals disparities in HFrEF management between Portuguese and non-Portuguese patients, particularly in ARNI use, with financial barriers affecting access in the African/Asian group. Despite similar clinical profiles, non-Portuguese patients had a higher risk of heart failure events, highlighting the impact of ethnic and socioeconomic factors on treatment and outcomes.</span></span></span></p>