Symptom Perception in Black Patients with Heart Failure (RPA Pilot / Seed Project)

Accurate symptom perception is problematic in patients with heart failure (HF), which results in delays in seeking medical care appropriately with escalating symptoms. Interoception is thought to be altered in HF. Poor interoceptive awareness results in inaccuracies in symptom detection, interpretation, and labeling. African Americans with HF delay longer seeking care than Whites. Symptom perception is a precipitating factor for care-seeking behaviors; however, whether symptom perception is poorer in African Americans compared with Whites is unclear. The purpose of this study is to 1) compare brain activity using functional magnetic resonance imaging (fMRI) in African American and White patients with HF who have high somatic awareness (i.e., highest quartile of the Heart Failure Somatic Perception Scale [HFSPS]) with those who have low somatic awareness (i.e., lowest quartile of HFSPS); and 2) to compare responses to a heartbeat detection test (symptom perception task) between African American and White patients in the highest and lowest quartiles of the HFSPS. A cross-sectional, 2-arm (high vs. low symptom perception) comparative feasibility study with stratification by race will be used to conduct this study of 10 African American and 10 White patients with HF. Patients ≥ 55 years with a cardiologist-confirmed HF diagnosis, reduced ejection fraction and New York Heart Association functional classification II–IV will be recruited and screened using the HFSPS. The HFSPS reflects the accuracy of symptom perception. Patients in the highest and lowest quartiles of HFSPS will be enrolled and will complete the heartbeat detection test, followed by resting brain fMRI. Functional MRI data will provide extensive preliminary data regarding the feasibility of this method. Connectivity analyses will be performed using MatLab and the CONN toolbox. Data from this study will be used as pilot data for an NIH R01 submission to further test mechanisms underlying poor symptom perception in HF.