Abstract 4366830: Symptoms of Bladder Incontinence Are Associated with Worse Functional Status and Quality of Life in Heart Failure with Preserved Ejection Fraction

Abstract

Introduction: Heart failure with preserved ejection fraction (HFpEF) is a geriatric syndrome characterized by a high burden of frailty, sarcopenia, and physical dysfunction. Given this clinical phenotype, patients with HFpEF would be anticipated to demonstrate elevated rates of incontinence; however, the prevalence and burden of bladder symptoms in this population and their associations with quality of life and physical function remain poorly characterized. Methods: This single-center study included patients enrolled in a prospective HFpEF registry at UT Southwestern between 8/2023-5/2025. Participants completed the Bladder Condition Assessment Tool (BCAT), a 4-item questionnaire that ranges from 0 to 20, with higher scores indicating more severe symptoms of incontinence. Outcomes included health-related quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ-12]), physical function (Short Physical Performance Battery [SPPB]), 6-minute walk distance (6MWD), and frailty (Fried Frailty Scale). Participants were stratified by data-derived BCAT tertiles representing minimal (tertile 1), intermediate (tertile 2), and severe (tertile 3) symptoms of incontinence. Linear regression assessed unadjusted associations between BCAT scores and outcomes, with additional adjustment for age, sex, and BMI. Results: 193 participants (age 70±12 years; 77% female; 29% Black) were included. The median (IQR) BCAT scores for the minimal, intermediate, and severe symptom groups were 3 (2-4), 7 (6-9), and 13 (11-15), respectively. Across symptom severity groups, there were no significant differences in age, sex, race, or comorbidities, though BMI was higher with greater symptom severity (p=0.042). In unadjusted analysis, severe (vs minimal/intermediate) symptoms were associated with worse 6MWD (β: -70 m; p=0.002), KCCQ-12 scores (β: -11; p=0.011), frailty (β: 0.52; p=0.005), and SPPB (β: -1.3; p=0.015). After adjustment, severe (vs minimal/intermediate) symptoms remained significantly associated with worse 6MWD (aβ: -50 m; p=0.022), KCCQ-12 scores (aβ: -9.0; p=0.036), and frailty (aβ: 0.46; p=0.016), with a trend towards worse SPPB Score (aβ: -0.92; p=0.075). Discussion: Worse symptoms of incontinence were associated with poorer physical function, decreased quality of life, and greater frailty. Given the substantial burden of symptoms in this population, clinicians should assess for incontinence as part of comprehensive HFpEF care.