Social Determinants of Health and Heart Failure

Social Determinants of Health & Heart Failure

Cardiovascular disease remains the leading cause of death globally, and nearly one million patients are newly diagnosed with heart failure (HF) in the United States each year.

There is increased interest in the role social determinants of health (SDoH) have in morbidity and mortality from chronic conditions such as HF.

Study Objective

To describe the social and medical characteristics of patients diagnosed with HF in a U.S. real-world cohort and to identify characteristics associated with 1-year survival.

Methods

Data were derived from the PremiOM^TM Heart Failure Dataset. Patients were included if they were alive, with all data elements available, at the beginning of the study period (6/30/2021 - 6/30/2022).

Patient characteristics by sex were described at baseline, which include age, race, New York Heart Association (NYHA) classification for HF severity, Charlson comorbidity index (CCI), and OM1 Medical Burden Index (OMBI^TM).

The OMBI^TM is a standardized measure of the combined medical burden, on a 0-1000 scale, generated from extensive analysis of OM1’s longitudinal patient cohort. Measures of SDoH included home ownership status, highest education level, and household income.

Logistic regression was used to quantify the association between patient and disease characteristics and 1-year survival.

OM1 Medical Burden Index (OMBI®)

measures the combined medical burden of an individual or a patient population.

This score is derived from extensive analysis of OM1’s longitudinal patient cohort. Scores range from 1-1000 and are aggregated into 10 categories that are highly predictive of future resource utilization and mortality.

Results

The analysis included 11,010 adult patients with HF (Table 1):

4,840 women, average age 74.6 years (SD 10.4)
6,170 men, average age 73.7 years (SD 10.0)

A lower medical burden was observed in women relative to men.

OMBI mean (SD): 644.9 (243.8) vs 653.4 (243.0)
CCI mean (SD): 3.5 (2.4) vs 3.7 (2.5)

Table 1. Patient Characteristics at Baseline

Results (continued)

After one year, 364 (3.3%) of patients had died of any cause.

Characteristics associated with lower odds of survival at one year (Table 2, Figure 1; presented with adjusted odds ratio, [95% confidence interval]) were:

Age, per 5 years: 0.7 (0.7, 0.8)
Higher NYHA class: 0.7 (0.6, 0.8)
OMBI (per 100 points): 0.9 (0.8, 0.9)
Higher CCI: 0.9 (0.8, 0.9)

In contrast, characteristics associated with increased odds of survival at one year were:

Higher annual income, per $10,000: 1.1 (1.0, 1.1)
Female sex: 1.5 (1.2, 1.8)
Home ownership: 1.5 (1.1, 2.1)

Table 2. Adjusted Odds Ratios (95% CI) of One Year Survival

Figure 1. Adjusted Odds Ratio (95% CI) of One Year Survival

Conclusions

In a real-world cohort of patients with HF, SDoH including higher household income and home ownership were independently associated with increased odds of all-cause 1-year survival.

Further research is needed to understand the ways in which SDoH may impact morbidity and mortality for patients with HF.