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Social Risk and Mortality: A Cohort Study in Patients With Advanced Heart Failure

Caterina Checa¹, Rosa Abellana, Jose-Maria Verdú-Rotellar

¹Caterina Checa, MSc, RN PhD Student, Primary Healthcare University Research Institute IDIAP-JordiGol; and Primary Healthcare Centre Dreta de l'Eixample, Barcelona; and Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain. Rosa Abellana, PhD Statistician, Primary Healthcare University Research Institute IDIAP-JordiGol, Barcelona, Spain. Jose-Maria Verdú-Rotellar, MD, PhD Senior Researcher, Primary Healthcare University Research Institute IDIAP-JordiGol, Barcelona; Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra; and Institut Català de la Salut, Barcelona, Spain. Anna Berenguera, PhD Senior Researcher, Primary Healthcare University Research Institute IDIAP-JordiGol, Barcelona; and Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain. Mar Domingo, MD, PhD Senior Researcher, Primary Healthcare University Research Institute IDIAP-JordiGol; and Institut Català de la Salut, Barcelona; and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Esther Calero, MSc, RN PhD Student, Primary Healthcare University Research Institute IDIAP-JordiGol; and Institut Català de la Salut, Barcelona, Spain. Miguel-Angel Muñoz Pérez, MD, PhD Senior Researcher, Primary Healthcare University Research Institute IDIAP-JordiGol, Barcelona; Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra; and Institut Català de la Salut, Barcelona, Spain.

The Journal of Cardiovascular Nursing

|October 20, 2018

Abstract

Background:

Heart failure (HF) is a chronic condition that usually leads to death a few years after diagnosis. Although several clinical factors have been found to be related to increased mortality, less is known about the impact of social context, especially at the end stage of the disease. Knowing about social context is important to properly classify risk and provide holistic management for patients with advanced HF.

Objective:

The aim of this study was to determine the impact of social context on mortality in patients with advanced HF.

Methods:

A retrospective cohort study was conducted using data from clinical records on community-dwelling patients with HF and with New York Heart Association IV functional class living in Catalonia in northeastern Spain. Clinical data, patient dependency for basic activities of daily living, and social assessments were collected between 2010 and 2013. The primary outcome was all-cause mortality.

Results:

Data from 1148 New York Heart Association class IV patients were analyzed. Mean (SD) age was 82 (9.0) years, and 61.7% were women. The mean (SD) follow-up was 18.2 (11.9) months. Mortality occurred in 592 patients. Social risk was identified in 63.6% of the patients, and 9.3% acknowledged having social problems. In the adjusted multivariate model, being male (hazard ratio (HR), 1.82; 95% confidence interval [CI], 1.16-2.83), having high dependency on others for basic activities of daily living (HR, 2.16; 95% CI, 1.21-3.85), and presenting with a social problem (HR, 2.46; 95% CI, 1.22-4.97) were related to an increased risk of mortality.

Conclusions:

An unfavorable social profile is an independent risk factor for mortality in patients with advanced HF.

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