Heart Failure Disparities in Native Hawaiians

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DESCRIPTION (provided by applicant): Heart failure (HF) is a major public health problem leading to considerable cardiovascular morbidity & mortality. The impact of HF on minority populations, such as Native Hawaiians (NHs) & other Pacific Peoples (PPs), is unknown. NHs are known to have high rates of risk factors for HF & one of the highest rates of cardiovascular disease (CVD) mortality in the U.S. Access to appropriate care is known to improve health outcomes for HF patients, but access to specialist care presents a major barrier for NHs & PPs because they tend to reside in medically underserved areas. To address HF disparities among NHs and PPs, a partnership program, the HF Disparities Program (HFD), will be established between the Queen Emma Clinic (QEC) and the Department of NH Health. Partners of the HFD Program include: MedStar Research Institute, Oahu-based Community Health Centers (CHCs) & the Hawaii EXPORT Center, an NIH-funded initiative addressing diabetes-associated disparities in NH/PP. The HFD Program will achieve the following research & educational aims: 1) Determine the reliability & validity of echocardiograms performed by community-based health workers compared to a professionally trained sonographer as the "gold standard". 2) Determine if a culturally competent educational program for heart failure reduces HF hospitalizations & mortality compared to usual care. 3) Characterize ethnic differences in the heart failure syndrome in hospitalized NHs & PPs compared to Caucasians. 4) Construct HF pedigrees using probands identified at the QEC for a future HF linkage study in NHs & PPs. 5) Educate community-based health workers to perform echocardiography scans for the detection of HF in a high risk population of NHs & PPs. 6) Train new investigators to conduct research focused on CVD disparities in general, and heart failure in particular. By achieving these aims, the HFD Program will improve access to HF care at CHCs that serve NHs & PPs, fill a gap in knowledge of CVD disparities in NHs & PPs and provide a foundation for future studies on genetic determinants of HF.