Impact of Socioeconomic Status on Mortality and Readmission in Patients With Heart Failure With Reduced Ejection Fraction: The ARIC Study.
Impact of Socioeconomic Status on Mortality and Readmission in Patients With Heart Failure With Reduced Ejection Fraction: The ARIC Study.
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DOI：
10.1161/jaha.121.024057
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发表时间：
2022-09-20
影响因子：
5.4
通讯作者：
Matsushita, Kunihiro
中科院分区：
文献类型：
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作者：
Mathews, Lena;Ding, Ning;Mok, Yejin;Shin, Jung-Im;Crews, Deidra C.;Rosamond, Wayne D.;Newton, Anna-Kucharska;Chang, Patricia P.;Ndumele, Chiadi E.;Coresh, Josef;Matsushita, Kunihiro
关键词：
低社会经济地位（SES）与心力衰竭（HF）的风险较高相关。个体和社区SES对射血分数降低的心力衰竭预后和护理质量的影响尚不清楚，但具有重要意义。我们检查了728名ARIC（社区动脉粥样硬化风险）研究的参与者（平均年龄，78.2岁; 34%的黑人参与者; 46%的女性），他们在2005年至2018年期间因射血分数降低（射血分数<50%）而住院。我们使用多变量考克斯模型评估了教育、收入和区域剥夺指数与死亡率和HF再入院之间的关系。我们还评估了出院时指南指导的药物治疗（最佳：≥3种β受体阻滞剂、盐皮质激素受体拮抗剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂;可接受：至少2种）的使用。在中位随访3.2年期间，58.7%因HF再次入院，74.0%死亡。低收入与较高的死亡率（风险比[HR]，1.52 [95%CI，1.14-2.04]）和再入院率（HR，1.45 [95%CI，1.04-2.03]）相关。同样，低教育水平与死亡率（HR，1.27 [95% CI，1.01-1.59]）和再入院（HR，1.62 [95% CI，1.24-2.12]）相关。最高与最低面积剥夺指数四分位数与再入院相关（HR，1.69 [95% CI，1.11-2.58]），但不一定与死亡率相关。最佳指南导向的药物治疗和可接受的指南导向的药物治疗的患病率分别为5.5%和54.4%，但SES没有显著差异。在射血分数降低的HF住院患者中，低SES与死亡率和HF再入院独立相关。有针对性的二级预防方法，集中精力在低SES的患者将是必要的，以改善与射血分数降低的HF的结果。
Low socioeconomic status (SES) is associated with a higher risk of heart failure (HF). The contribution of individual and neighborhood SES to the prognosis and quality of care for HF with reduced ejection fraction is not clear yet has important implications. We examined 728 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 78.2 years; 34% Black participants; 46% women) hospitalized with HF with reduced ejection fraction (ejection fraction <50%) between 2005 and 2018. We assessed associations between education, income, and area deprivation index with mortality and HF readmission using multivariable Cox models. We also evaluated the use of guideline‐directed medical therapy (optimal: ≥3 of ß‐blockers, mineralocorticoid receptor antagonist, angiotensin‐converting enzyme inhibitors, or angiotensin receptor blockers; acceptable: at least 2) at discharge. During a median follow‐up of 3.2 years, 58.7% were readmitted with HF, and 74.0% died. Low income was associated with higher mortality (hazard ratio [HR], 1.52 [95% CI, 1.14–2.04]) and readmission (HR, 1.45 [95% CI, 1.04–2.03]). Similarly, low education was associated with mortality (HR, 1.27 [95% CI, 1.01–1.59]) and readmission (HR, 1.62 [95% CI, 1.24–2.12]). The highest versus lowest area deprivation index quartile was associated with readmission (HR, 1.69 [95% CI, 1.11–2.58]) but not necessarily with mortality. The prevalence of optimal guideline‐directed medical therapy and acceptable guideline‐directed medical therapy was 5.5% and 54.4%, respectively, but did not significantly differ by SES. Among patients hospitalized with HF with reduced ejection fraction, low SES was independently associated with mortality and HF readmission. A targeted secondary prevention approach that focuses intensive efforts on patients with low SES will be necessary to improve outcomes of those with HF with reduced ejection fraction.