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QOL and Physical Functioning in Black and White Adults With HCM
Quick Takes
- Few studies have addressed QOL and physical functioning in Black patients living with hypertrophic cardiomyopathy (HCM).
- In this study, female gender, younger age, and higher BMI were associated with low levels of physical functioning, and female gender, mid-ventricular obstruction, and higher BMI were associated with poor QOL.
Study Questions:
What are the differences in quality of life (QOL) and physical functioning between Blacks and Whites with hypertrophic cardiomyopathy (HCM)?
Methods:
A subgroup secondary analysis of an ongoing prospective longitudinal study on HCM conducted at a northeastern US academic HCM referral center was performed on data from 434 adult participants who self-identified as Black or White with HCM. Structural HCM clinical characteristics were extracted from echocardiography data. QOL was measured using the Minnesota Living With Heart Failure Questionnaire (MLWHFQ). Physical function was measured using symptom-limited stress echocardiogram for exercise capacity (absolute and categorical metabolic equivalents, which were adjusted for age) and New York Heart Association (NYHA) functional status (class I-IV).
Results:
Of the eligible sample cases (434 patients), 57 (13.1%) were Black and 180 (41.5%) patients were women. Black patients were significantly younger than White patients (54.6 vs. 62.5 years, p = 0.001). On average, Black patients had higher MLWHFQ scores, meaning worse QOL than White patients (31.2 vs. 23.9, p = 0.042). In the combined Black and White cohort, female gender (odds ratio [OR], 2.493; 95% confidence interval [CI], 0.968-1.004; p = 0.001), mid-ventricular obstruction (OR, 0.897; 95% CI, 0.490-1.640), and body mass index (BMI) ≥30 kg/m2 (OR, 2.744; 95% CI, 1.574-4.782; p = 0.035) were associated with poor QOL (MLWHFQ scores ≥45).
Exercise stress echocardiogram (i.e., exercise capacity) data were available for 280 patient cases (39 Black and 241 White patients). Female gender (OR, 3.047; 95% CI, 1.778-5.223; p < 0.001) and BMI ≥30 kg/m2 (OR, 2.969; 95% CI, 1.715-5.140; p < 0.001) were significantly associated with below average exercise capacity for age. Female gender (OR, 2.518; 95% CI. 1.627-3.896; p < 0.001) and younger age (OR, 0.984; 95% CI, 0.970-0.999; p = 0.032) were independent predictors for higher level NYHA classification.
Conclusions:
This secondary analysis study of an ongoing prospective longitudinal study on HCM uncovered differences between Black and White patients’ QOL and physical functioning that might have otherwise remained obscured. While Black patients were under-represented in this sample, this sample is similar to those reported in the HCM literature. Findings indicate the need for further research with women living with HCM to examine QOL and ways to address worsening QOL in women. Teasing out domain-specific areas of QOL (e.g., physical, emotional, social) among Black patients with HCM is needed in future research.
Perspective:
QOL and physical functioning are important aspects of care needing to be addressed among patients living with HCM. This research begins to uncover differences and similarities in Black and White persons receiving specialty care at an HCM referral center in terms of QOL and physical functioning. Future research is needed that will tease out the emotional, physical, and social, as well as environmental factors impacting QOL and physical functioning in community-dwelling adults.
Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound
Keywords: African Americans, Body Mass Index, Cardiomyopathies, Cardiomyopathy, Hypertrophic, Echocardiography, Exercise Tolerance, Heart Failure, Motor Skills, Patient Care Team, Quality of Life, Secondary Prevention, Women
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