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Socioeconomic deprivation may increase death, hospitalization in chronic HF
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Socioeconomic deprivation is linked to increased risk of death and hospitalization due to an excess of non-CV events in patients with chronic HF, according to results published in Heart.
“The prevalence of chronic HF continues to rise, due to both improving survival from its antecedents, such as ischemic heart disease, and reducing mortality in patients with established chronic HF,” Klaus K. Witte, MD, from the Multidisciplinary Cardiovascular Research Center, University of Leeds, England, and colleagues wrote. “As such, the personal and economic burdens of the disorder are increasingly relevant to health care planning and policy.”
According to the researchers, socioeconomic status is recognized as an important cause of health care-related inequalities, but its relevance to the burden of hospitalization in patients with chronic HF is unexplored.
The researchers conducted a prospective cohort study of 1,802 unselected patients with chronic HF treated in cardiology outpatient clinics of four U.K. hospitals. They assessed the link between deprivation as determined by the U.K. Index of Multiple Deprivation and mode-specific mortality, mode-specific hospitalization and cumulative duration of hospitalization.
Patients were included in the study if they showed stable clinical signs and symptoms of chronic HF for 3 months, with left ventricular ejection fraction 45% defined by transthoracic echocardiography.
Witte and colleagues found a 45-point difference in mean Index of Multiple Deprivation score between patients living in the least and most deprived quintiles of geographical regions.
Age, sex and comorbidity were all associated with deprivation, but chronic HF symptoms, LVEF and prescribed drug therapy were not.
Index of Multiple Deprivation score was associated with the risk for age-sex adjusted all-cause mortality (6% higher risk per 10-unit increase in score; 95% CI, 2-10; P = .004) and non-CV mortality (9% higher risk per 10-unit increase in score; 95% CI, 3-16; P = .003), but not CV mortality.
All-cause hospitalization was also more common in the most deprived patients, but HF-specific hospitalization was not.
At 1 year, patients spent a cumulative 3.3 days in the hospital, and Index of Multiple Deprivation score was linked with cumulative duration of hospitalizations after adjustment for age and sex (4% increase in duration per 10-unit increase in score; 95% CI, 3-6; P < .0005), the researchers wrote.
According to Witte and colleagues, the study provides the most comprehensive available assessment of the association between socioeconomic deprivation and adverse outcomes in people with chronic HF.
“While HF symptoms, short-term cardiac remodeling and provision of evidence-based medical therapy were comparable across quintiles of [Index of Multiple Deprivation], deprivation was associated with increased all-cause mortality and hospitalization,” the researchers wrote. “Overall, our observations provide circumstantial support for a causal link between deprivation and the burden of non-cardiovascular mortality and morbidity in people with chronic HF, raising the question of whether outcomes can be improved by non-cardiovascular and social interventions.”– by Dave Quaile
Disclosure: The authors report no relevant financial disclosures.
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