Impact on socioeconomic status with HFrEF outcomes

1. Amongst patients with HFrEF, lower socioeconomic status was associated with increased rates of HFrEF readmission and all-cause mortality, even when adjusting for usage of guideline-directed medical therapies (GDMTs).

Evidence Rating Level: 2 (Good)

Heart failure (HF) affects over 6.5 million people in the USA, but advancements in guideline-directed medical therapies (GDMTs) have improved rates for mortality and readmission in those with reduced ejection fraction (HFrEF). While lower socioeconomic status (SES) is associated with higher rates of incident HF, there is not as much known about SES and HFrEF prognosis, where uptake of GDMTs has a profound effect on outcomes. Therefore, this current study examined the association between SES and the risk of HFrEF readmission and all-cause mortality. SES was measured in several different ways, including income, education level, and area deprivation index (ADI) quartile. The cohort was taken from the Atherosclerosis Risk in Communities (ARIC) study, which has 15,792 participants based out of communities in 3 states, and between 2005 and 2018, there were 728 eligible patients who had HFrEF events. The results showed that low income <$12,000 compared to income >$50,000 was associated with increased mortality (hazards ratio 1.52, 95% CI 1.14-2.04), and low income also increased the risk of HFrEF readmission (HR 1.45, 95% CI 1.04-2.03). Additionally, having below a high school education level was associated with increased mortality (HR 1.27, 95% CI 1.01-1.59) and readmission (HR 1.62, 95% CI 1.24-2.12), whereas ADI had no mortality association, but an increased readmission risk (HR 1.69, 95% CI 1.11-1.28). Finally, even after adjusting for uptake of GDMT, there still remained associations between low SES and poorer HFrEF prognosis. Overall, this study demonstrated that numerous metrics of lower SES were associated with increased HFrEF readmission and all-cause mortality, regardless of GDMT status.

Click to read the study in JAHA

Image: PD

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