Race and the Presence of an Implantable Cardioverter Defibrillator Moderate the Relationship Between Gender and Quality of Life

Background Women with heart failure (HF) have greater symptom burden and worse quality of life (QOL) compared to men with HF. Black, Indigenous, and people of color (BIPOC) are diagnosed with HF in larger numbers earlier in life, reporting worse QOL than their White counterparts. Despite these differences in diagnosis and QOL, women and BIPOC patients with HF have historically been undertreated with ICDs. These differences are due to both healthcare providers offering and patients accepting the devices in a differential manner. Current treatment guidelines and recommendations include calls to increase the number of ICDs implanted in women and BIPOC patients with HF. Gender, race, and ICD implantation are associated with QOL in patients with HF, however, little is known about how these factors interact to affect QOL. Objective To determine the moderating effect of race and the presence of an ICD on the relationship between gender and QOL in HF patients. Methods In this secondary analysis, we used a database of multiple studies of patients with HF from an academic research registry. A moderated moderation regression (model 3) was conducted using the Hayes SPSS PROCESS macro controlling for age, NYHA class, rural residence, and education. Quality of Life was measured using the Minnesota Living with Heart Failure Questionnaire with higher scores indicating worse QOL. Results We included 623 people living with HF (BIPOC 38%, with ICD 47%, female 38%, age 62+13 years, NYHA class III-IV 51%). Significant differences in QOL (p= .001) were found between women (48.1 + 24.6) and men (39.5 + 25.3). The model explained 23.7% of the variance of QOL (p< .001). We found a significant effect of the three-way interaction among race, ICD implant, and gender on QOL (p=0.014, Figure 1). White women with ICDs reported the worst QOL (58.8), while BIPOC men without ICDs reported the best QOL (40.2). Conclusion Further studies are needed to determine population level specific interventions to provide patient-centered support during HF treatment to improve QOL in all HF patients, rather than simply increasing the number of devices implanted. Women with heart failure (HF) have greater symptom burden and worse quality of life (QOL) compared to men with HF. Black, Indigenous, and people of color (BIPOC) are diagnosed with HF in larger numbers earlier in life, reporting worse QOL than their White counterparts. Despite these differences in diagnosis and QOL, women and BIPOC patients with HF have historically been undertreated with ICDs. These differences are due to both healthcare providers offering and patients accepting the devices in a differential manner. Current treatment guidelines and recommendations include calls to increase the number of ICDs implanted in women and BIPOC patients with HF. Gender, race, and ICD implantation are associated with QOL in patients with HF, however, little is known about how these factors interact to affect QOL. To determine the moderating effect of race and the presence of an ICD on the relationship between gender and QOL in HF patients. In this secondary analysis, we used a database of multiple studies of patients with HF from an academic research registry. A moderated moderation regression (model 3) was conducted using the Hayes SPSS PROCESS macro controlling for age, NYHA class, rural residence, and education. Quality of Life was measured using the Minnesota Living with Heart Failure Questionnaire with higher scores indicating worse QOL. We included 623 people living with HF (BIPOC 38%, with ICD 47%, female 38%, age 62+13 years, NYHA class III-IV 51%). Significant differences in QOL (p= .001) were found between women (48.1 + 24.6) and men (39.5 + 25.3). The model explained 23.7% of the variance of QOL (p< .001). We found a significant effect of the three-way interaction among race, ICD implant, and gender on QOL (p=0.014, Figure 1). White women with ICDs reported the worst QOL (58.8), while BIPOC men without ICDs reported the best QOL (40.2). Further studies are needed to determine population level specific interventions to provide patient-centered support during HF treatment to improve QOL in all HF patients, rather than simply increasing the number of devices implanted.