Related Experiment Video

Updated: Jan 18, 2026

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
05:16

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure

Published on: June 10, 2025

535

Disparities in Diagnostic Utilization Patterns Between Heart Failure With Preserved Ejection Fraction (HFpEF) and

Kiki J Estes-Schmalzl1, Wondwossen T Lerebo2, Mitchell Wolden1

  • 1Department of Health Sciences, University of Jamestown, Fargo, USA.

Cureus
|September 10, 2025
PubMed

Insights

Diagnostic imaging disparities exist for heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). These inequities are driven by race, socioeconomic factors, and geography, impacting care access.

Area of Science:

  • Cardiology
  • Health Services Research
  • Health Equity

Background:

  • Heart failure (HF) is a major cause of illness and hospitalization, with distinct HFpEF and HFrEF phenotypes.
  • Disparities in diagnostic imaging utilization may lead to underdiagnosis and unequal care for HF patients.
  • Understanding the influence of social determinants of health (SDoH) on diagnostic imaging is crucial for equitable care.

Purpose of the Study:

  • To evaluate differences in combined diagnostic imaging utilization between HFpEF and HFrEF.
  • To examine the impact of SDoH and hospital region on diagnostic imaging disparities in HF.
  • To identify factors contributing to underutilization of diagnostic imaging in HF care.

Main Methods:

  • Retrospective cross-sectional study using the 2020 National Inpatient Sample (NIS).
  • Identified adult HF hospitalizations using ICD-10 codes.
  • Analyzed associations between diagnostic imaging (echocardiography, MRI, cardiac catheterization) and patient/hospital-level factors using multivariable logistic regression.

Main Results:

  • Low overall utilization of combined diagnostic imaging (1.72%) across 6.47 million HF admissions.
  • Significant racial disparities observed: Black patients had lower odds for HFpEF diagnosis but higher odds for HFrEF diagnosis compared to White patients.
  • Income, education, employment, and hospital region were significant predictors of imaging disparities; cardiac catheterization strongly associated with both HF phenotypes.

Conclusions:

  • Marked disparities in diagnostic imaging for HFpEF and HFrEF are driven by race, socioeconomic status, and geography.
  • Underutilization of essential diagnostic imaging persists, particularly among minoritized and disadvantaged populations.
  • Targeted interventions are necessary to address diagnostic access barriers and promote equitable HF care.

Keywords:
advanced cardiac imagingdiagnostic accessechocardiogramhealth disparitieshealthcare inequalityheart failure with preserved ejection fraction (hfpef)hfref (heart failure with reduced ejection fraction)racial disparitysocial determinantssocial determinants of health

More Related Videos

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs07:09

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs

Published on: February 18, 2022

2.3K
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction09:20

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

7.0K

Related Concept Videos

Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
3.0K
Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
323
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
752
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
223
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
812
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
480