Co-Morbid Conditions in Underserved Low-Income African Americans with Heart Failure

Background Non-cardiac co-morbid conditions occur in 20-30%, and depression occurs in 15-26% of patients with heart failure. This can undercut the quality of care, but little is known about co-morbidities in underserved urban African Americans with heart failure, the population subgroup at the greatest risk. Hypothesis Medical and psychological comorbidities are prevalent among underserved urban African Americans with heart failure. Methods: We analyzed data from Congestive Heart failure Adherence Redesign Trial (CHART), which is funded by the national heart lung and blood institute (NCT 01698242). CHART is a multi-level clinical trial aimed at improving adherence in low income patients having heart failure with reduced ejection fraction (HFrEF). The trial recruited 320 patients from 5 minority serving hospitals in Chicago with a self-reported annual income of Results This population was: 25.3% ≥ 65 years, 42.5% female, 86.6% African American, and 66.5% below the federal poverty line. Baseline analysis of co-morbid conditions showed that 241 (75.3%) had more than 3 non-cardiac chronic comorbidities Major depression existed in 54 (16.9%), post-traumatic stress disorder existed in 34 (10.6%), and participants experienced a median of 3 major traumatic events, including being involved in gun violence, witnessing a murder, and being a victim of sexual or physical assault. Approximately one-third were not taking their medications as prescribed, as reported via electronic pill caps. Conclusions Multiple medical comorbidities, depression, post-traumatic stress disorder, and non-compliance with medical therapy are highly prevalent among underserved low-income African Americans with HFrEF. Therefore, it is urgent to extend quality care in this special population beyond a single focus on the condition of the heart.