Racial/Ethnic Disparities in Heart Failure: A Cross Cohort Collaboration

摘要 心力衰竭(HF)及其按保留(HFpEF)、减少(HFrEF)或中度(HFmrEF)定义的亚型 射血分数是一个重大且日益严重的公共卫生问题。这个项目的长期目标是 了解有关心力衰竭的健康差距，并制定有效的预防措施，以减少 这些差异。我们建议汇集来自10个大型纵向队列研究的数据，以检查种族/民族 以及发生心力衰竭的性别差异、其亚型及其预后。协调后的数据将包括 130,028名男性和女性，超过8975名做出类似判断的预期心力衰竭结果，代表着广泛的 美国的年龄、种族/民族和地理区域的范围。这一交叉队列 合作将提供一个独特的机会，对性别和种族/民族进行全面评估。 心力衰竭患者的健康差异。将使用因果调解分析技术来估计 单因素和多因素的生活方式和临床干预可能会减少心力衰竭患者的健康差距。在我们的 表型映射目标，我们将基于队列数据定义独特的临床相关的HF表型，即 也通常出现在医疗记录中，以增强概括性，包括年龄、种族/民族、性别、 临床体征、症状、生物标志物、射血分数、生理指标和合并症；我们还将 评估心力衰竭表型与心血管疾病和全因死亡率的关系。

ABSTRACT Heart failure (HF), and its subtypes defined by preserved (HFpEF), reduced (HFrEF) or mid-range (HFmrEF) ejection fraction are a major and growing public health problem. The long term goal of this project is to better understand the health disparities regarding HF and define effective preventive measures that may reduce these disparities. We propose to pool data from 10 large longitudinal cohort studies to examine race/ethnic and sex disparities in developing HF, its subtypes, and its prognosis. The harmonized data will include over 130,028 men and women with over 8975 similarly-adjudicated prospective HF outcomes, representing a wide spectrum of ages, race/ethnicities, and geographic regions of the United States. This cross-cohort collaboration will provide a unique opportunity to conduct a comprehensive evaluation of sex and racial/ethnic health disparities in HF. Causal mediation analysis techniques will be used to estimate the degree to which single and multi-factor lifestyle and clinical interventions could potentially reduce health disparities in HF. In our phenomapping aim, we will define unique clinically relevant phenotypes of HF based upon cohort data that is also commonly present in medical records for enhanced generalizability, including age, race/ethnicity, sex, clinical signs, symptoms, biomarkers, ejection fraction, physiologic measures, and co-morbidities; we will also evaluate HF phenotype associations with CVD and all-cause mortality.