Abstract 4123886: Health Disparities in Quality of Life among Black Patients with Heart Failure: the Roles of Depressive Symptoms and Functional Status

Background: Black patients with heart failure (HF) have a higher physical and psychological distress which disproportionately worsens their health and quality of life (QOL) than those from other racial/ethnic groups. Black patients less commonly receive optimal therapy for HF than white patients, which can result in poorer functional status. Black patients report higher levels of depressive symptoms. Higher levels of depressive symptoms can further worsen functional status and lower QOL. Hypothesis: We hypothesized that depressive symptoms would predict QOL in Black patients with HF and that this relationship would be mediated by functional status. Methods: Using the RICH Heart Program HF Database, we included all 226 Black patients (57±12 years old, 49% male) with HF, who completed the Patient Health Questionnaire-9 to measure depressive symptoms, the Duke Activity Status Index for functional status, and the Minnesota Living with Heart Failure Questionnaire for QOL. Mediation analysis was performed using the PROCESS macro. Results: Depressive symptoms were directly associated with QOL (effect coefficient [c’] =2.386, 95% confidence interval [CI] = 2.549, 3.450). There was a significant indirect effect of depressive symptoms on QOL mediated by functional status (ab=0.614, 95% CI [0.406, 0.856]). Those with worse depressive symptoms had lower functional status (a = -0.901, p< 0.001), in turn, lower functional status was associated with worse QOL (b = -0.681 p<0.001). Conclusions: Depressive symptoms are directly associated with QOL and there also is an indirect association, mediated by functional status in Black patients with HF. Inequities in the management of HF among Black patients that contribute to these findings must be explored as the causes of the disparity in depressive symptoms are not yet known.