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Race- and Ethnicity-Related Differences in Heart Failure With Preserved Ejection Fraction Using Natural
Sam Brown1,2, Dhruva Biswas1,2, Jack Wu2
1King's College Hospital NHS Foundation Trust, London, United Kingdom.
JACC. Advances
|July 25, 2024
Summary
Established heart failure with preserved ejection fraction (HFpEF) diagnostic tools underdiagnose HFpEF in Black patients. This is likely due to differences in comorbidity patterns, highlighting a need for improved diagnostic approaches in diverse populations.
Area of Science:
- Cardiology
- Medical Informatics
- Health Equity
Background:
- Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure in older adults.
- HFpEF is a heterogeneous syndrome with limited understanding across different ethnicities.
- Ethnic variations in clinical presentation and diagnostic tool performance for HFpEF are not well-characterized.
Purpose of the Study:
- To compare the clinical presentation of HFpEF across different ethnic groups.
- To assess the diagnostic performance of existing HFpEF diagnostic tools in various ethnicities.
- To identify potential health inequities in HFpEF diagnosis.
Main Methods:
- A Natural Language Processing (NLP) algorithm analyzed electronic health records from a London hospital.
- Patients meeting European Society of Cardiology criteria for HFpEF were identified.
- Data on demographics, comorbidities, biomarkers (NT-proBNP), H2FPEF scores, and echocardiograms were extracted and stratified by ethnicity.
Main Results:
- The cohort included 1,261 White, 578 Black, and 134 Asian patients.
- Black patients were younger at diagnosis and had higher rates of metabolic comorbidities (obesity, diabetes, hypertension) than White patients.
- Black patients exhibited lower NT-proBNP levels and a lower frequency of H2FPEF scores indicative of HFpEF compared to White patients.
Conclusions:
- NLP-based AI identified systematic underdiagnosis of HFpEF in Black patients using established markers.
- Differences in comorbidity patterns may explain the underdiagnosis in Black patients.
- Clinicians must recognize these diagnostic limitations and their implications for treatment and clinical trial recruitment.
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