Estes-Schmalzl Kiki J, Lerebo Wondwossen T, Wolden Mitchell, Lefebvre Kristin M
Department of Health Sciences, University of Jamestown, Fargo, USA.
Department of Radiology, Children's Hospital of Philadelphia, Maryland, USA.
Cureus. 2025 Aug 8;17(8):e89634. doi: 10.7759/cureus.89634. eCollection 2025 Aug.
Background Heart failure (HF) is a leading cause of morbidity and hospitalization, encompassing distinct phenotypes: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Disparities in diagnostic imaging may contribute to underdiagnosis and unequal care. This study evaluates differences in combined diagnostic imaging utilization between HFpEF and HFrEF, focusing on social determinants of health (SDoH) and hospital region. Methods We conducted a retrospective cross-sectional study using the 2020 National Inpatient Sample (NIS). Adults (≥18 years) hospitalized with HF were identified using International Classification of Diseases, 10th revision (ICD-10) codes. The primary outcome was receipt of any diagnostic imaging (composite of echocardiography, cardiac magnetic resonance imaging (MRI), and cardiac catheterization). We examined associations between imaging and patient-level (race, income, education, insurance, employment) and hospital-level (region) factors using separate multivariable logistic regression models for HFpEF and HFrEF groups. Results Among 6.47 million weighted HF admissions, 6.95% were HFpEF and 6.55% were HFrEF. Combined diagnostic imaging utilization was low overall (1.72%). After adjustment, Black patients had lower odds of HFpEF diagnosis (adjusted odds ratio (aOR) 0.83, 95% confidence interval (CI): 0.83-0.84) but higher odds for HFrEF (aOR 1.24, 95% CI: 1.23-1.25) than White patients. Cardiac catheterization was strongly associated with both phenotypes (HFpEF, aOR 3.68, 95% CI: 3.62-3.73; HFrEF, aOR 6.23; 95% CI: 6.14-6.32; all p<0.001). Income, education, employment, and hospital region were all significant predictors of imaging disparities. Conclusion Marked disparities in diagnostic imaging exist for both HF phenotypes, driven by race, socioeconomic status, and geography. Despite the clinical importance of imaging, underutilization persists, particularly among minoritized and disadvantaged populations, exacerbated by structural barriers. Implementing targeted interventions to address diagnostic access is essential for equitable HF care.
心力衰竭（HF）是发病和住院的主要原因，包括不同的表型：射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）。诊断成像方面的差异可能导致诊断不足和医疗不平等。本研究评估HFpEF和HFrEF在联合诊断成像利用方面的差异，重点关注健康的社会决定因素（SDoH）和医院所在地区。方法：我们使用2020年全国住院患者样本（NIS）进行了一项回顾性横断面研究。使用国际疾病分类第10版（ICD-10）编码识别因HF住院的成年人（≥18岁）。主要结局是接受任何诊断成像检查（超声心动图、心脏磁共振成像（MRI）和心导管检查的综合结果）。我们使用针对HFpEF和HFrEF组的单独多变量逻辑回归模型，研究成像与患者层面（种族、收入、教育、保险、就业）和医院层面（地区）因素之间的关联。结果：在647万例加权HF住院病例中，6.95%为HFpEF，6.55%为HFrEF。联合诊断成像的总体利用率较低（1.72%）。调整后，黑人患者被诊断为HFpEF的几率较低（调整后的优势比（aOR）为0.83，95%置信区间（CI）：0.83-0.84），但被诊断为HFrEF的几率高于白人患者（aOR为1.24，95%CI：1.23-1.25）。心导管检查与两种表型均密切相关（HFpEF，aOR为3.68，95%CI：3.62-3.73；HFrEF，aOR为6.23；95%CI：6.14-6.32；所有p<0.001）。收入、教育、就业和医院所在地区都是成像差异的重要预测因素。结论：两种HF表型在诊断成像方面存在明显差异，这是由种族、社会经济地位和地理位置驱动的。尽管成像在临床上很重要，但利用率仍然较低，尤其是在少数族裔和弱势群体中，结构性障碍加剧了这种情况。实施有针对性的干预措施以解决诊断获取问题对于公平的HF护理至关重要。
