Advertisement

Quality of life and physical functioning in black and white adults with hypertrophic cardiomyopathy

      Highlights

      • Black adults are underrepresented in QOL/physical functioning research in HCM.
      • MLWHF scores were higher in the Black cohort but QOL categories were similar to the White cohort.
      • Comprehensive quality of life measures, including psychosocial stress, are needed.
      • NYHA class alone is inadequate to evaluate physical function in Black adults with HCM.

      Abstract

      Background

      Hypertrophic cardiomyopathy (HCM) is a common and clinically heterogeneous inherited cardiac disease. Quality of life (QOL) and physical functioning are important clinically but are underexplored in diverse populations with HCM.

      Objectives

      To examine predictors for and compare QOL and physical functioning in Black and White adults with HCM.

      Methods

      We analyzed a sub-sample from a longitudinal prospective study on HCM. Eligibility criteria included self-identified Black and White adults (≥18 years) with clinical HCM. QOL was measured with the Minnesota Living with Heart Failure Questionnaire (MLWHF);physical functioning included age-adjusted exercise capacity and NYHA class. Covariates included HCM structural characteristics and common comorbidities. We analyzed data from 434 individuals, 57 (13.1%) of whom self-identified as Black/African American. Results: In this sample, the Black cohort had higher MLWHF scores, 31.2 (27.2) v. 23.9 (22.1), p=0.042, signifying worse QOL, but there were no intergroup differences when QOL was dichotomized. Mean metabolic equivalents (METs) on symptom-limited stress testing were similar, though the Black cohort was younger, 54.6 (13.4) v.62.5 (14.8) years, p=0.001. No one from the Black cohort achieved an “excellent-for-age” exercise capacity, and 64.1% had a “below-average-for-age” exercise capacity vs 47% in the White cohort, though this was not statistically significant, p=0.058. There was no difference between groups in advanced NYHA class. Female gender was associated with worse QOL and physical functioning irrespective of covariates.

      Conclusions

      This study is a starting point that underscores the need for a more comprehensive examination of well-being and physical functioning in Black populations with HCM.

      Keywords

      Abbreviation:

      BMI (Body Mass Index (kg/m2)), CAD (Coronary Artery Disease), HCM (Hypertrophic cardiomyopathy), HTN (Hypertension), LV (Left ventricular), LVH (Left ventricular hypertrophy), LVOTO (Left ventricular outflow tract obstruction), METs (Metabolic equivalents), MLWHF (Minnesota Living with Heart Failure), TIA (Transient Ischemic Attack)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Semsarian C
        • Ingles J
        • Maron MS
        • Maron BJ.
        New perspectives on the prevalence of hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2015; 65: 1249-1254
        • Maron BJ
        • Rowin EJ
        • Maron MS.
        Global burden of hypertrophic cardiomyopathy.
        JACC Heart Fail. 2018; 6: 376-378
      1. Census U. Population 2021 [Available from: https://www.census.gov/topics/population.html.

        • Maron BJ
        • Rowin EJ
        • Udelson JE
        • Maron MS.
        Clinical spectrum and management of heart failure in hypertrophic cardiomyopathy.
        JACC Heart Fail. 2018; 6: 353-363
        • Michels M
        • Olivotto I
        • Asselbergs F
        • van der Velden J.
        Life-long tailoring of management for patients with hypertrophic cardiomyopathy.
        Netherlands Heart J. 2017; 25: 186-199
      2. Maron BJ, Casey SA, Olivotto I, Sherrid MV, Semsarian C, Autore C, et al. Clinical course and quality of life in high-risk patients with hypertrophic cardiomyopathy and implantable cardioverter-defibrillators. Circulation–Arrhythmia and Electrophysiology. 2018;11(4):e005820.

        • Capota R
        • Militaru S
        • Ionescu AA
        • Rosca M
        • Baicus C
        • Popescu BA
        • et al.
        Quality of life status determinants in hypertrophic cardiomyopathy as evaluated by the Kansas City Cardiomyopathy Questionnaire.
        Health Qual Life Outcomes. 2020; 18: 1
        • Cox S
        • O'Donoghue AC
        • McKenna WJ
        Steptoe A. Health related quality of life and psychological wellbeing in patients with hypertrophic cardiomyopathy.
        Heart. 1997; 78: 182-187
        • Christiaans I
        • Van Langen IM
        • Birnie E
        • Bonsel GJ
        • Wilde AA
        • Smets EM.
        Quality of life and psychological distress in hypertrophic cardiomyopathy mutation carriers–A cross-sectional cohort study.
        Am J Med Genet A. 2009; 149: 602-612
        • Pedrosa RP
        • Lima SG
        • Drager LF
        • Genta PR
        • Amaro AC
        • Antunes MO
        • et al.
        Sleep quality and quality of life in patients with hypertrophic cardiomyopathy.
        Cardiology. 2010; 117: 200-206
        • Magnusson P
        • Mörner S
        • Gadler F
        • Karlsson J.
        Health-related quality of life in hypertrophic cardiomyopathy patients with implantable defibrillators.
        Health Qual Life Outcomes. 2016; 14: 1-9
        • Arabadjian M
        • McCarthy M
        • Dickson VV.
        An integrated review of hypertrophic cardiomyopathy in black populations–Underrecognized and understudied.
        J Cardiovasc Nurs. 2021; 36: 104-115
        • Harmon KG
        • Asif IM
        • Maleszewski JJ
        • Owens DS
        • Prutkin JM
        • Salerno JC
        • Zigman ML
        • Ellenbogen R
        • Rao AL
        • Ackerman MJ
        • Drezner JA.
        Incidence, cause, and comparative frequency of sudden cardiac death in national collegiate athletic association athletes–A decade in review.
        Circulation. 2015; 132: 10-19
        • Maron BJ
        • Carney KP
        • Lever HM
        • Lewis JF
        • Barac I
        • Casey SA
        • Sherrid MV.
        Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2003; 41: 974-980
        • Eberly LA
        • Eleazu I
        • Channaoui N
        • Picard K
        • Cirino A
        • Cope R
        • et al.
        Racial differences in the use of genetic testing among patients with hypertrophic cardiomyopathy.
        J Card Fail. 2019; 25: S137
        • Eberly LA
        • Day SM
        • Ashley EA
        • Jacoby DL
        • Jefferies JL
        • Colan SD
        • Rossano JW
        • Semsarian C
        • Pereira AC
        • Olivotto I
        • Ingles J.
        Association of race with disease expression and clinical outcomes among patients with hypertrophic cardiomyopathy.
        JAMA Cardiol. 2020; 5: 83-91
        • Rowin EJ
        • Maron BJ
        • Olivotto I
        • Maron MS.
        Role of exercise testing in hypertrophic cardiomyopathy.
        JACC. 2017; 10: 1374-1386
        • Sorensen LL
        • Pinheiro A
        • Dimaano VL
        • Pozios I
        • Nowbar A
        • Liu HY
        • et al.
        Comparison of clinical features in blacks versus whites with hypertrophic cardiomyopathy.
        Am J Cardiol. 2016; 117: 1815-1820
        • van Tol BA
        • Huijsmans RJ
        • Kroon DW
        • Schothorst M
        • Kwakkel G.
        Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure–A meta-analysis.
        Eur J Heart Fail. 2006; 8: 841-850
        • Arabadjian Milla E.
        • et al.
        Disease expression and outcomes in Black and White adults with hypertrophic cardiomyopathy.
        J Am Heart Assoc. 2021; 10e019978
      3. Maron, Barry J., et al. "Clinical course and quality of life in high-risk patients with hypertrophic cardiomyopathy and implantable cardioverter-defibrillators." Circulation: Arrhythmia and Electrophysiology 11.4 (2018):e005820.

        • Ommen SR
        • Mital S
        • Burke MA
        • Day SM
        • Deswal A
        • Elliott P
        • et al.
        2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy–A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines.
        J Am Coll Cardiol. 2020; 76: e159-e240
        • Ferrans CE
        • Zerwic JJ
        • Wilbur JE
        • Larson JL.
        Conceptual model of health-related quality of life.
        J Nurs Scholarsh. 2005; 37: 336-342
        • Duangchan C
        • Matthews AK.
        Application of Ferrans et al.'s conceptual model of health-related quality of life–A systematic review.
        Res Nurs Health. 2021; 44: 490-512
        • Saengsiri AO.
        Factors predicting quality of life for coronary artery disease patients after percutaneous coronary intervention.
        Asian Biomed. 2014; 8https://doi.org/10.5372/1905-7415.0801.259
        • Haywood K
        • Whitehead L
        • Nadkarni VM
        • Achana F
        • Beesems S
        • Böttiger BW
        • Brooks A
        • Castrén M
        • Ong ME
        • Hazinski MF
        • Koster RW.
        COSCA (Core Outcome Set for Cardiac Arrest) in adults–An advisory statement from the International Liaison Committee on Resuscitation.
        Circulation. 2018; 137: e783-e801
        • Heo S
        • Lennie TA
        • Moser DK
        • Kennedy RL.
        Types of social support and their relationships to physical and depressive symptoms and health-related quality of life in patients with heart failure.
        Heart Lung. 2014; 43: 299-305
        • Bilbao A
        • Escobar A
        • García-Perez L
        • Navarro G
        • Quirós R.
        The Minnesota living with heart failure questionnaire–Comparison of different factor structures.
        Health Qual Life Outcomes. 2016; 14: 1-11
        • Behlouli H
        • Feldman DE
        • Ducharme A
        • Frenette M
        • Giannetti N
        • Grondin F
        • et al.
        Identifying relative cut-off scores with neural networks for interpretation of the Minnesota Living with Heart Failure questionnaire.
        in: 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE, 2009
        • The Criteria Committee of the New York Heart Association
        Functional capacity and objective assessment.
        in: Dolgin M. Nomenclature And Criteria For Diagnosis Of Diseases Of The Heart And Great Vessels. 9th ed. Little, Brown and Company, Boston, MA1994: 253-255
        • Jetté M
        • Sidney K
        • Blümchen G.
        Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity.
        Clin Cardiol. 1990; 13: 555-565
        • Minami Y
        • Kajimoto K
        • Terajima Y
        • Yashiro B
        • Okayama D
        • Haruki S
        • et al.
        Clinical implications of midventricular obstruction in patients with hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2011; 57: 2346-2355
        • Carbone S
        • Canada JM
        • Buckley LF
        • Trankle CR
        • Dixon DL
        • Buzzetti R
        • et al.
        Obesity contributes to exercise intolerance in heart failure with preserved ejection fraction.
        J Am Coll Cardiol. 2016; 68: 2487-2488
        • Reddy YN
        • Rikhi A
        • Obokata M
        • Shah SJ
        • Lewis GD
        • AbouEzzedine OF
        • et al.
        Quality of life in heart failure with preserved ejection fraction–Importance of obesity, functional capacity, and physical inactivity.
        Eur J Heart Fail. 2020; 22: 1009-1018
        • Rowin EJ
        • Maron MS
        • Wells S
        • Patel PP
        • Koethe BC
        • Maron BJ.
        Impact of sex on clinical course and survival in the contemporary treatment era for hypertrophic cardiomyopathy.
        J Am Heart Assoc. 2019; 8e012041
        • Lewsey Sabra C.
        • Breathett Khadijah
        Racial and ethnic disparities in heart failure–Current state and future directions.
        Curr Opin Cardiol. 2021; 36: 320-328
        • Mwansa Hunter
        • et al.
        Racial/ethnic and gender disparities in heart failure with reduced ejection fraction.
        Curr Heart Fail Rep. 2021; 18: 41-51https://doi.org/10.1007/s11897-021-00502-5