# Understanding and addressing risks of low socioeconomic status and diabetes for heart failure

> **NIH NIH P50** · JOHNS HOPKINS UNIVERSITY · 2021 · $695,533

## Abstract

Summary
Heart failure (HF) is associated with high morbidity, mortality and costs, and there is great interest in refining
strategies to reduce HF risk. Diabetes (DM) and low socioeconomic status (SES) are each independent risk
factors for HF, and both factors together have a synergistic association with incident HF. A major functional
consequence of these associations is impaired cardiorespiratory fitness, with implications for prognosis and
quality of life. Additionally, low SES and DM are over-represented among racial and ethnic minorities and
therefore a cause of HF disparities. Strategies to address the high HF risk associated with the combination of
low SES and DM will require a focus on social determinants of health. Problem-solving training and community
health worker (CHW) support are effective in overcoming barriers to care, and improving lifestyle, DM self-
management, health system engagement and risk factor control, but they have not yet been applied to
addressing HF risk. Prevention efforts would be further informed by understanding geographic disparities in HF
risk and elucidating clinical risk factors that might serve as targets for intervention. We therefore propose a
randomized trial among 350 persons with low SES, DM, obesity and early cardiac dysfunction, testing the
effects of a multi-level intervention of problem-solving training, CHW support and partnership with community
facilities to support lifestyle change on fitness, risk factor control, markers of cardiac injury/fibrosis and quality
of life. We propose: Aim 1: To use electronic medical record data to a) compare the association of
neighborhood SES with incident HF in patients with DM, across urban, rural and suburban settings,
and b) to identify modifiable clinical risk factors for HF associated with DM that are more prevalent in
persons with low SES. Aim 2: To adapt an evidence-based, pragmatic intervention to improve
functional status and risk factor control in persons with low SES, DM, obesity and early cardiac
dysfunction, using community-based participatory research (CBPR) and patient-centered outcomes
research (PCOR) principles. Aim 3: To test, in a randomized controlled trial, if a 1-year multilevel
intervention of problem-solving training, CHW use to enhance social support and health system
engagement, and use of community facilities to support lifestyle change improves cardiorespiratory
fitness and related outcomes in those with low SES, DM, obesity and early cardiac dysfunction, more
than enhanced education and connection with community health programs. This work will elucidate
strategies to address HF risk related to low SES and DM, which are key contributors to HF disparities.

## Key facts

- **NIH application ID:** 10437340
- **Project number:** 1P50MD017348-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Chiadi E Ndumele
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $695,533
- **Award type:** 1
- **Project period:** 2021-09-24 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10437340

## Citation

> US National Institutes of Health, RePORTER application 10437340, Understanding and addressing risks of low socioeconomic status and diabetes for heart failure (1P50MD017348-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10437340. Licensed CC0.

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