AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Income Disparities in Mortality and Resource Use Among Hospitalized HFpEF Patients: A National Analysis
By Towfig MF, Sule-Saa S, Sackey JA et al.
Background: Heart Failure Preserved Ejection Fraction (HFpEF) now accounts for more than half of all heart failure cases in the United States, yet it remains one of the hardest conditions to diagnose. Confirming the diagnosis requires echocardiography, biomarkers, and often advanced cardiac imaging tools that are far less accessible to low-income patients. Whether income independently drives worse outcomes during hospitalization has not been examined at the national level. Method: We used the National Inpatient Sample (2016-2021) to identify adults older than 50 hospitalized with HFpEF. Patients were grouped by ZIP code-based income quartile, with the highest quartile as the reference. The primary outcome was in-hospital mortality. Secondary outcomes were total cost, total charges, and length of stay. All models were adjusted for age, sex, race, co morbidities, hospital bed size, and insurance status using survey-weighted multivariable regression. Result: Lowest-income patients had 14% higher odds of in-hospital death compared to the highest income group (OR 1.14, 95% CI 1.13-1.16, p<0.001), with a clear stepwise pattern across quartiles (2nd quartile OR 1.08; 3rd quartile OR 1.03, all p<0.001). Despite higher mortality, they accumulated lower total costs (–$3,230) and charges (–$13,352), reflecting fewer diagnostic and therapeutic interventions rather than more efficient care. The lowest income group also had a longer length of stay (+0.07 days, p<0.001). This disparity widened sharply from 2019 to 2021, likely driven by pandemic-era disruptions. Conclusion: Low-income patients with HFpEF face higher in-hospital mortality yet receive fewer diagnostic and therapeutic interventions, a paradox that reflects unequal access rather than unequal need. Given that HFpEF diagnosis hinges on echocardiogram and advanced imaging, patients who cannot afford or access these tools are dying without adequate workup or treatment. Addressing this requires systematic changes such as income-neutral referral pathways, broader access to cardiac imaging, and targeted resource allocation for underserved populations.