Abstract Body: Background: Asian American, Native Hawaiian, and other Pacific Islander (AANHPI) persons comprise ~10% of the U.S. population—24 million people—yet a significant gap exists in contemporary data on incident heart failure (HF).

Methods: We identified adults ≥30 years without cardiovascular disease (CVD) within Kaiser Permanente Northern California and Hawaii from 2012-2022. Incident HF was defined as a hospitalization, >3 clinic visits, or death due to HF, based on validated diagnostic codes and death certificates. We reported age-sex-adjusted incidence per 1,000 person-years by AANHPI subgroup with [95% confidence intervals] and calculated adjusted hazard ratios for incident HF in each subgroup compared to non-Hispanic Whites.

Results: Among 2,653,007 million adults without CVD, mean age was 49±15 years and 53% were women. CVD risk factor prevalence was high, including hypertension (22%), dyslipidemia (26%), diabetes (7%), and overweight/obesity (56%). The cohort's self-reported racial/ethnic breakdown and rates of incident HF were: 6.8% Chinese (2.64 [2.55-2.73]), 7.3% Filipino (5.07 [4.93-5.22]), 2.4% Native Hawaiian/other Pacific Islander (8.75 [8.31-9.21]), 1.7% Japanese (3.07 [2.91-3.24]), 0.8% Korean (2.44 [2.15-2.74]), 3.5% South Asian (5.46 [5.1-5.84]), 1.9% Vietnamese (3.05 [2.74-3.37]), 1.0% other Southeast Asian (4.71 [4.1-5.36]), and 74.5% Non-Hispanic White (4.52 [4.49-4.56]). Adjusting for age, sex, and CVD risk factors, Chinese, Filipino, Japanese, Korean, and Vietnamese adults had lower risk of incident HF, while Native Hawaiian/other Pacific Islander and South Asian adults had higher risk compared to non-Hispanic White adults (Figure).

Conclusions: Most AANHPI subgroups had lower adjusted risk of incident HF compared to non-Hispanic White adults, with Native Hawaiian/Pacific Islander and South Asian adults being notable exceptions. Our findings underscore the importance of disaggregating race and ethnicity to better understand risk profiles and mediators of incident HF.