Socioeconomic Factors Affect many Heart Failure Patients

According to UT Southwestern Medical Center experts, the majority of Americans suffering from heart failure confront significant financial hurdles.

The study, published in The American Journal of Cardiology, found that two or more socioeconomic determinants of health (SDOH) have a negative impact on 8 out of 10 ambulatory heart failure patients. Nonmedical issues such as economic insecurity, a lack of access to care, or harsh living conditions can all have an impact on health outcomes. Minorities of all races and ethnicities, as well as those with low incomes, are disproportionately affected.

This is the first study to evaluate the nationwide prevalence of unfavorable SDOH in heart failure patients, and it builds on previous studies including UT Southwestern patients.

“Heart failure is a chronic medical condition that requires close follow-up, long-term medication use, and lifestyle change, but adverse SDOH are common barriers to optimal management,” said study leader Andrew Sumarsono, M.D., M.P.H., Assistant Professor of Internal Medicine in the Division of Hospital Medicine at UT Southwestern. “Our research shows that adverse SDOH are exceedingly common in the heart failure population in the U.S. and that they tend to impact minority groups more significantly. Developing targeted social interventions to address these adverse SDOH can likely help improve heart failure care on a population level.”

UTSW researchers pooled publically accessible data from the 1999 to 2018 National Health and Nutrition Examination Surveys, which collected information from a cross-section of U.S. people, to better understand the prevalence of unfavorable SDOH in heart failure patients. The UTSW team was able to employ weighting processes based on the survey design so that its findings could be applied to the full US population.

The researchers identified individuals with a self-reported history of heart failure and analyzed data by race, ethnicity, and SDOH characteristics outlined by the American Heart Association, such as socioeconomic position (income, education, unemployment rates); access to care (uninsurance rates, no routine place for care); environment (food insecurity, household crowding); and health status (sleep deprivation, physical activity levels, and disabilities).

In total, 1,906 people were recognized in the study. They represent an estimated 5.25 million heart failure patients in the United States. According to the survey, around 81.4% of heart failure patients reported harmful effects from two or more SDOH variables.

Lower-income respondents reported significantly greater rates of adverse SDOH than higher-income respondents, and substantial ethnic/racial variations in SDOH reporting were detected in education, uninsurance, food security, home crowding, and sleep deprivation.

Food insecurity, for example, was twice as prevalent among Black and Hispanic respondents as it was among white patients, and minority patients reported much higher rates of home congestion (11 times higher among Hispanic respondents and four times higher among Black respondents).

“Millions of Americans suffer from heart failure, where the heart muscle is weakened and can’t pump blood properly,” said Lajjaben Patel, M.B.B.S., a postdoctoral researcher in UTSW’s Cardiometabolic Research Unit, who served as first author of the study. “When they have access to proper care and support, however, they can successfully manage their condition. The next step in our research is to identify which social determinants have the greatest impact on clinical outcomes and test specific interventions to determine their benefit.”

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