Abstract 19097: Socioeconomic Disparities in Symptomatic Heart Failure in Patients With Acute Myeloid Leukemia

Introduction: Patients with acute myeloid leukemia (AML) have a high risk of symptomatic heart failure (HF). In addition, socioeconomic status (SES) has a significant effect on cardiovascular health. However, little is known about the association of SES and HF in patients with AML.

Hypothesis: To investigate the impact of SES in HF occurring after AML.

Methods: All adult patients diagnosed with AML between August 2006 to November 2019 at the hospital of University of Pennsylvania were studied. The primary outcome was new-onset symptomatic HF defined by 2017 ACC/AHA guidelines. The median household income (MHI) was identified based on ZIP codes using the data.census.gov. Low-income was defined as MHI lower than the MHI of the United States in the same time period. Differences between low-income Black and other patients were determined using t-tests, chi-square or Mann Whitney U test. Fine and Gray’s subdistribution hazard regression analysis was used to identify characteristics associated with HF.

Results: A total of 770 patients (404 men, age: 62±15 years) were included; 101 (13.1%) were Black, 669 (86.9%) White. Seventy-six patients (9.9%) experienced symptomatic HF during a median follow-up period of 442 days. The median time to HF was 106 days [46-243]. Seventy-six (75%) Black and 181 (27.1%) White patients had low-income. Low-income Black had more cardiovascular (CV) risks (≥ 2 CV risks 39.5% vs 25.1%, p=0.009) and more HF events (11 events, 19% vs 65 events, 9.1%, p=0.022), than other patients. No differences were noted in history of cardiovascular diseases, cardiovascular treatments, doses of anthracyclines, and non-cardiac death between low-income Black and other patients. The cumulative incidence of HF in low-income Black patients was higher (p=0.01). Low-income Black (HR: 2.02; 95% CI: 1.05 to 3.88; p=0.036) and hypertension (HR: 1.90; 95% CI: 1.14 to 3.16; p=0.014) were independent factors associated with HF.

Conclusions: Low-income Black patients with AML have a higher rate of new-onset symptomatic HF, independently of their cardiovascular and cancer treatment. Whether these differences are due to genetic or environmental factors remains unknown.