Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial.
Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial.
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DOI：
10.1161/circoutcomes.113.000911
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发表时间：
2014-09
期刊：
影响因子：
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通讯作者：
Krumholz HM
中科院分区：
文献类型：
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作者：
Bikdeli B;Wayda B;Bao H;Ross JS;Xu X;Chaudhry SI;Spertus JA;Bernheim SM;Lindenauer PK;Krumholz HM
最近的研究表明，社区水平的社会经济地位（SES）和心力衰竭患者的结果之间的关联。我们不知道社区SES是否具有主要效应，或者是个体SES的标记。我们使用了从33个美国内科和心脏病学实践中招募的Tele-HF试验参与者的数据，并检查了社区SES与心力衰竭患者结局之间的相关性。我们使用人口普查区作为社区的代理，并构建了包括财富和收入，教育和职业信息的SES分数摘要。主要终点为6个月时的再入院率和全因死亡率。我们进行了患者访谈和病历审查，以获得人口统计学信息，临床因素，治疗和个人SES。我们纳入了1557名患者：分别来自低、中和高SES社区的524、516和517名患者（平均年龄：61.1 ± 15.2岁，42.2%为女性）。总体而言，745例患者（47.8%）至少有一次再入院，179例患者（11.5%）死亡。与高SES社区的患者相比，生活在低SES社区的患者更容易再次入院（比值比：1.35，95%置信区间：1.01-1.82），但死亡率无显著差异（比值比：0.78，95%置信区间：0.50-1.18）。在对个体人口统计学、临床因素和个体SES进行多变量调整后，结果一致。在心力衰竭患者中，即使在调整了其他患者水平因素（包括个体SES）后，社区SES与6个月全因再入院显著相关。需要更多的事件和更长的随访时间来确定社区SES对死亡率的潜在影响。NIH临床试验编号NCT 00303212，可访问：http://clinicaltrials.gov/show/NCT00303212
Recent studies show an association between neighborhood-level measures of socioeconomic status (SES) and outcomes for patients with heart failure. We do not know if neighborhood SES has a primary effect or is a marker for individual SES. We used the data from participants of the Tele-HF trial, recruited from 33 US internal medicine and cardiology practices, and examined the association between neighborhood SES and outcomes of patients with heart failure. We used census tracts as proxies for neighborhoods and constructed summary SES scores that included information about wealth and income, education, and occupation. The primary endpoints were readmission and all-cause mortality at 6 month. We conducted patient interviews and medical chart reviews to obtain demographic information, clinical factors, therapies, and individual SES. We included 1557 patients: 524, 516, and 517 from low, medium, and high SES neighborhoods, respectively (mean age: 61.1 ± 15.2 years, 42.2% female). Overall, 745 patients (47.8%) had at least one readmission and 179 patients (11.5%) died. Compared with patients in high SES neighborhoods, those living in low SES neighborhoods were more likely to be readmitted (odds ratio: 1.35, 95% confidence interval: 1.01–1.82) but the mortality rates were not significantly different (odds ratio: 0.78, 95% confidence interval: 0.50–1.18). The results were consistent after multivariable adjustments for individual demographics, clinical factors, and individual SES. Among patients with heart failure, neighborhood SES was significantly associated with 6-month all-cause readmission even after adjusting for other patient-level factors, including individual SES. Greater number of events and longer follow-up is required to ascertain the potential impact of neighborhood SES on mortality. NIH Clinical Trials #NCT00303212, accessible at: http://clinicaltrials.gov/show/NCT00303212