Socioeconomic status and prognosis of heart failure with reduced vs.
preserved ejection fraction: A propensity-matched study in the
community.
Abstract
Background: The relationship between socioeconomic status (SES) and the
prognosis of HF with reduced (HFrEF) vs. preserved (HFpEF) ejection
fraction remains unsettled. Objective: To analyze the relationship
between SES and the prognosis of patients with incident HFrEF and HFpEF.
Methods: Prospective study over 15 years (2003-2017) on 9658 patients
diagnosed with HF. Main outcomes were mortality and hospitalizations for
HF. The independent relationship between SES and the prognosis,
stratifying patients for cardiovascular co-morbidity after propensity
score-matching was analyzed. Results: After matching 7116 patients,
during a median follow-up of 8.11 years, 5616 patients died (78.9%) and
5549 patients were hospitalized (78.0%). High income level was
associated with a lower all-cause mortality (RR for HF patients [95%
CI]: 0.86 [0.80-0.92], RR for HFrEF: 0.88 [0.82-0.95] and RR
for HFpEF: 0.82 [0.75-0.90], P <0.001 in all cases), and
cardiovascular mortality (RR for HF: 0.84 [0.76-0.92], RR for HFrEF:
0.87 [0.81-0.93] and RR for HFpEF: 0.88 [0.77-0.88], P
<0.001 in all cases), less hospitalizations (RR for HF: 0.70
[0.65-0.78], RR for HFrEF: 0.78 [0.68-0.88] and RR for HFpEF:
0.61 [0.55-0.68], P <0.001 in all cases), and less 30-day
readmissions (RR for HF: 0.67 [0.59-0.75], RR for HFrEF: 0.71
[0.63-0.79] and RR for HFpEF: 0.61 [0.55-0.69], P
<0.001 in all cases), after adjustment for comorbidities, and
other potential confounders. Analyses of recurrent hospitalizations gave
larger SES benefits than time-to-first-event analyses. Conclusions: In
this propensity-matched study, a high net annual household income is
associated with an improved prognosis of patients with incident HFrEF
and HFpEF.