Dataset Information

Impact of sex, socio-economic status, and remoteness on therapy and survival in heart failure.

ABSTRACT:

Aims

This study aims to determine if traditional markers of disadvantage [female sex, low socio-economic status (SES), and remoteness] are associated with lower prescription of evidence-based therapy and higher mortality among patients with moderate-severe heart failure with reduced ejection fraction.

Methods and results

We recruited 452 consecutive class II-III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence-based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow-up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74-1.92, 0.48). There was no difference in prescription of beta-blockers [χ² (1) = 0.91, 0.66], angiotensin-converting enzyme inhibitors [χ² (1) = 0.001, 0.97], nor aldosterone antagonists [χ² (1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter-defibrillator implantation in men compared with women [χ² (1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit.

Conclusions

In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.

SUBMITTER: Gutman SJ

PROVIDER: S-EPMC6816230 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Publications

Impact of sex, socio-economic status, and remoteness on therapy and survival in heart failure.

Gutman Sarah J SJ Costello Ben T BT Papapostolou Stavroula S Iles Leah L Ja Johnson J Hare James L JL Ellims Andris A Marwick Thomas H TH Taylor Andrew J AJ

ESC heart failure 20191016 5

<h4>Aims</h4>This study aims to determine if traditional markers of disadvantage [female sex, low socio-economic status (SES), and remoteness] are associated with lower prescription of evidence-based therapy and higher mortality among patients with moderate-severe heart failure with reduced ejection fraction.<h4>Methods and results</h4>We recruited 452 consecutive class II-III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary o ...[more]

PMID: 31618531

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Project description:AimsThis study explored the association between socio-economic status (SES) and mortality among patients hospitalized for heart failure (HF) in China.Methods and resultsWe used data from the China Patient-centred Evaluative Assessment of Cardiac Events-Prospective Heart Failure Study (China PEACE 5p-HF Study), which enrolled patients hospitalized primarily for HF from 52 hospitals between 2016 and 2018. SES was measured using the income, employment status, educational attainment, and partner status. Individual socio-economic risk factor (SERF) scores were assigned based on the number of coexisting SERFs, including low income, unemployed status, low education, and unpartnered status. We assessed the effects of SES on 1 year all-cause mortality using Cox models. We used the Harrell c statistic to investigate whether SES added incremental prognostic information for mortality prediction. A total of 4725 patients were included in the analysis. The median (interquartile range) age was 67 (57-76) years; 37.6% were women. In risk-adjusted analyses, patients with low/middle income [low income: hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.21-2.14; middle income: HR 1.32, 95% CI 1.00-1.74], unemployment status (HR 1.43, 95% CI 1.10-1.86), low education (HR 1.25, 95% CI 1.03-1.53), and unpartnered status (HR 1.22, 95% CI 1.03-1.46) had a higher risk of death than patients with high income, who were employed, who had a high education level, and who had a partner, respectively. Compared with the patients without SERFs, those with 1, 2, 3, and 4 SERFs had 1.52-, 2.01-, 2.45-, and 3.20-fold increased risk of death, respectively. The addition of SES to fully adjusted model improved the mortality prediction, with increments in c statistic of 0.01 (P < 0.01).ConclusionsIn a national Chinese cohort of patients hospitalized for HF, low income, unemployment status, low education, and unpartnered status were all associated with a higher risk of death 1 year following discharge. In addition, incorporating SES into a clinical-based model could better identify patients at risk for death. Tailored clinical interventions are needed to mitigate the excess risk experienced by those socio-economic deprived HF patients.

Project description:BackgroundThere is a paucity of data regarding the impact of remoteness of residence (RoR) and socioeconomic status (SES) on access to care and outcomes for children with congenital heart disease (CHD) or acquired heart disease (AHD) in a jurisdiction of universal health and centralized cardiac care.ObjectivesThe primary objective was to examine whether RoR, SES, and their interaction impact access to health care and outcomes for children with heart disease in Alberta, Canada.MethodsThis was a population-based study of children with CHD or AHD born between January 1, 2005, and December 31, 2017, in Alberta, Canada. Primary outcomes included age at diagnosis, time from diagnosis to intervention, number of annual primary care visits, annual cardiologist visits, annual emergency room visits, and survival. Multivariable Cox proportional hazards models identified independent associations. Longitudinal relationships between the number of annual physician visits and RoR and SES were assessed with multivariable Poisson models.ResultsWe included 12,542 children (94% CHD, 6% AHD), 70.4% living <60 minutes' drive of a cardiac center, and 10.9% residing >180 minutes away. RoR and SES were not associated with age at diagnosis, time from diagnosis to intervention, annual primary care visits, or transplant free survival for either CHD or AHD. Although SES demonstrated no impact, annual annual cardiologist visits were inversely related to RoR for CHD (60-180 minutes rate ratio [RR]: 0.83, 95% CI: 0.73-0.95; >180 minutes RR: 0.77, 95% CI: 0.67-0.88; P < 0.0001) and AHD (60-180 minutes RR: 0.63, 95% CI: 0.39-1.00; >180 minutes RR: 0.53, 95% CI: 0.34-0.84; P = 0.02). Additionally, increased annual emergency room visits were associated with further RoR (P < 0.001) in both CHD and AHD and lower SES (P < 0.001) only for those with CHD.ConclusionsAge at diagnosis, time to intervention, annual primary care visits, and transplant-free all-cause survival were not impacted by RoR or SES in children with heart disease. Greater RoR and SES, however, were associated with fewer annual cardiology visits and increased annual emergency room visits, which highlights the need for novel surveillance strategies for remote pediatric patients with heart disease.

Project description:Socio-economic status (SES) has been associated with incident and prevalent heart failure (HF), as well as its morbidity and mortality. However, the precise nature of the relationship between SES and HF remains unclear due to inconsistent data. This study aims to provide a comprehensive assessment and data synthesis of the relationship between SES and HF morbidity and mortality. We performed a systematic search and data synthesis using six databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The included studies comprised observational studies that reported on HF incidence and prevalence, HF hospitalizations, worsening HF (WHF) and all-cause mortality, as well as treatment options (medical, device and advanced HF therapies). SES was measured on both individual and area levels, encompassing single (e.g., income, education, employment, social risk score, living conditions and housing characteristics) and composite indicators. Among the 4124 studies screened, 79 were included, with an additional 5 identified through cross-referencing. In the majority of studies, a low SES was associated with an increased HF incidence (72%) and prevalence (75%). For mortality, we demonstrated that low SES was associated with increased mortality in 45% of the studies, with 18% of the studies showing mixed results (depending on the indicator, gender or follow-up) and 38% showing non-significant results. Similar patterns were observed for the association between SES, WHF, medical therapy prescriptions and the utilization of devices and advanced HF therapies. There was no clear pattern in the used SES indicators and HF outcomes. This systematic review, using contemporary data, shows that while socio-economic disparity may influence HF incidence, management and subsequent adverse events, these associations are not uniformly predictive. Our review highlights that the impact of SES varies depending on the specific indicators used, reflecting the complexity of its influence on health disparities. Assessment and recognition of SES as an important risk factor can assist clinicians in early detection and customizing HF treatment, while also aiding policymakers in optimizing resource allocation.

Project description:ImportanceIn the face of an emerging heart failure (HF) epidemic, describing the association between perceived economic burden (PEB) and health care outcomes is an important step toward more equitable and achievable care.ObjectivesTo examine the association between PEB and risk of 1-year clinical outcomes and HF-specific health status in patients with acute decompensated HF.Design, setting, and participantsThis prospective, multicenter, hospital-based cohort study prospectively enrolled adult patients hospitalized for acute decompensated HF at 52 hospitals in China from August 2016 to May 2018, with 1-year follow-up. Data were analyzed on June 17, 2022.ExposurePerceived economic burden, categorized as severe (cannot undertake expenses), moderate (can almost undertake expenses), or little (can easily undertake expenses).Main outcomes and measuresThe clinical outcomes of the study were 1-year all-cause death and rehospitalization for HF. Heart failure-specific health status was assessed by the 12-Item Kansas City Cardiomyopathy Questionnaire (KCCQ-12).ResultsAmong 3386 patients, median age was 67 years (IQR, 58-75 years) and 2116 (62.5%) were men. Of these patients, 404 (11.9%) had severe PEB; 2021 (59.7%), moderate PEB; and 961 (28.4%), little PEB. Compared with patients with little PEB, those with severe PEB had increased risk of 1-year mortality (hazard ratio [HR], 1.61; 95% CI, 1.21-2.13; P < .001) but not 1-year HF rehospitalization (HR, 1.21; 95% CI, 0.98-1.49; P = .07). The mean (SD) adjusted KCCQ-12 score was lowest in patients with severe PEB and highest in patients with little PEB at baseline (40.0 [1.7] and 50.2 [1.0] points, respectively; P < .001) and at each visit (eg, 12 months: 61.5 [1.6] and 75.5 [0.9] points respectively; P < .001). Patients reporting severe PEB had a clinically significant lower 1-year KCCQ-12 score compared with those reporting little PEB (mean difference, -11.3 points; 95% CI, -14.9 to -7.6 points; P < .001).Conclusions and relevanceIn this cohort study of patients with acute decompensated HF, greater PEB was associated with higher risk of mortality and poorer health status but not with risk of HF rehospitalization. The findings suggest that PEB may serve as a convenient tool for risk estimation and as a potential target for quality-improvement interventions for patients with HF.

Dataset Information

Impact of sex, socio-economic status, and remoteness on therapy and survival in heart failure.

Aims

Methods and results

Conclusions

Publications

Impact of sex, socio-economic status, and remoteness on therapy and survival in heart failure.

Similar Datasets

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