Understanding and addressing risks of low socioeconomic status and diabetes for heart failure

Johns Hopkins University, Baltimore MD

Investigators

Linked publications, trials & patents

Abstract

Heart failure (HF) is associated with high morbidity, mortality and costs, and there is great interest in refining strategies to reduce HF risk. Diabetes (DM) and low SES are each independent risk factors for HF, and both factors together have a synergistic association with incident HF. A major functional consequence of these associations is impaired cardiorespiratory fitness, with implications for prognosis and quality of life. . Strategies to address the high HF risk associated with the combination of low SES and DM will require a focus on unmet health and social needs. Problem-solving training and community health worker (CHW) support are effective in overcoming challenges in receiving care, and improving lifestyle, DM self-management, health system engagement and risk factor control, but they have not yet been applied to addressing HF risk. Prevention efforts would be further informed by understanding geographic differences in HF risk and elucidating clinical risk factors that might serve as targets for intervention. We therefore propose a randomized trial among 350 persons with low SES, DM, obesity and early cardiac dysfunction, testing the effects of a multi-level intervention of problem-solving training, CHW support and partnership with community facilities to support lifestyle change on fitness, risk factor control, markers of cardiac injury/fibrosis and quality of life. We propose: Aim 1: To use electronic medical record data to a) compare the association of neighborhood SES with incident HF in patients with DM, across urban, rural and suburban settings, and b) to identify modifiable clinical risk factors for HF associated with DM that are more prevalent in persons with low SES. Aim 2: To adapt an evidence-based, pragmatic intervention to improve functional status and risk factor control in persons with low SES, DM, obesity and early cardiac dysfunction, using community-based participatory research (CBPR) and patient-centered outcomes research (PCOR) principles. Aim 3: To test, in a randomized controlled trial, if a 1-year multilevel intervention of problem-solving training, CHW use to enhance social support and health system engagement, and use of community facilities to support lifestyle change improves cardiorespiratory fitness and related outcomes in those with low SES, DM, obesity and early cardiac dysfunction, more than enhanced education and connection with community health programs. This work will elucidate strategies to address HF risk related to low SES and DM.