Elsevier

American Heart Journal

Volume 152, Issue 2, August 2006, Pages 371-378
American Heart Journal

Clinical Investigation
Outcomes, Health Policy, and Managed Care
Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: Findings from the National Heart Failure Project

https://doi.org/10.1016/j.ahj.2005.12.002Get rights and content

Background

Prior studies have reported conflicting findings concerning the association of socioeconomic status (SES), treatment, and outcomes in patients hospitalized with heart failure (HF).

Methods

We conducted a retrospective analysis of medical record data from a national sample of Medicare beneficiaries hospitalized with HF between March 1998 and April 1999 (n = 25 086) to assess the association of patient SES, treatment, and outcomes. Patients' SES was designated as lower, lower-middle, higher-middle, and higher using residential ZIP code characteristics. Patients were evaluated for left ventricular systolic function assessment, prescription of angiotensin-converting enzyme inhibitors at discharge, readmission within 1 year of discharge, and mortality within 30 days and 1 year of admission. Hierarchical logistic regression models were used to assess the association of SES, quality of care, and outcomes adjusting for patient, physician, and hospital characteristics.

Results

Lower SES patients (relative risk [RR] 0.92, 95% CI 0.87-0.96) were modestly less likely to have had a left ventricular systolic function assessment, but had a similar adjusted likelihood of being prescribed angiotensin-converting enzyme inhibitors (RR 1.03, 95% CI 0.93-1.11) compared with higher SES patients after multivariable adjustment. Socioeconomic status was not associated with 30-day mortality after multivariable adjustment, but lower SES patients had a higher risk of 1-year mortality (RR 1.10, 95% CI 1.02-1.19) and readmission within 1 year of discharge (RR 1.08, 95% CI 1.03-1.12) compared with higher SES patients.

Conclusions

Socioeconomic status in patients hospitalized with HF was not strongly associated with quality of care or 30-day mortality. However, the increased risk of 1-year mortality and readmission among patients of lower SES suggest SES may influence outcomes after hospitalization for HF.

Section snippets

National Heart Care Project

The Centers for Medicare & Medicaid Services National Heart Care Project is an ongoing quality of care initiative for Medicare beneficiaries hospitalized with cardiovascular diseases, including HF. As part of the project, a cohort of fee-for-service Medicare beneficiaries hospitalized with a principal discharge diagnosis of HF (International Classification of Diseases, Ninth Revision, Clinical Modification code 402.01, 402.11, 402.91, 404.01, 404.91, or 428)20 between March 1998 and April 1999

Results

Of the 25 086 patients, 13.6% were classified as lower SES, 53.6% as lower-middle SES, 22.3% as higher-middle SES, and 10.6% as higher SES. Lower SES patients were younger on average, and greater proportions were female and nonwhite than upper class patients. Lower SES patients had a lower prevalence of coronary disease, prior myocardial infarction, prior coronary revascularization, and aortic stenosis, but a higher prevalence of diabetes, chronic obstructive pulmonary disease, and hypertension

Discussion

Lower class elderly patients hospitalized with HF had a higher risk of readmission and 1-year mortality than upper class patients. Similarly, patients with fewer socioeconomic resources had lower rates of LVSF assessment, but similar rates of ACE inhibitor and ACE inhibitor or ARB prescription than upper class patients. These findings suggest that patient SES is associated with selected variations in quality of care and has a more consistent association with longer-term outcomes among elderly

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  • Cited by (0)

    Mr Rathore is supported by NIH/NIGMS Medical Scientist Training Grant GM07205. Dr Masoudi is supported by NIH/NIA Research Career Award K08-AG01011. Dr Foody is supported by NIH/NIA Research Career Award K08-AG20623-01 and a NIA/Hartford Foundation Fellowship in Geriatrics.

    The analyses upon which this publication is based were performed under Contract Number 500-02-CO-01, entitled, “Utilization and Quality Control Peer Review Organization for the State of Colorado,” sponsored by the Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration), US Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does mention of trade names, commercial products, or organization imply endorsement by the US Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor.

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