Impact of Neighborhood Factors on Heart Failure Outcomes: Secondary Analysis From the Hopeful Heart Trial

Few studies have examined the impact of neighborhood-level factors on outcomes for patients with heart failure with reduced ejection fraction (HFrEF).

The purpose of this study was to understand the impact of neighborhood factors on readmission and mortality risk hospitalized patients with HFrEF.

We analyzed data from the Hopeful Heart Trial that evaluated the impact of blended collaborative care for treating HFrEF and depression among patients discharged from 8 Pittsburgh-area hospitals from March 2014 to October 2017. Using patients' home address at discharge to determine neighborhood Walk Score (WS; 0-100 scale) and Area Deprivation Index (ADI; 0-100), we examined the incidence of 12-month all-cause and cardiovascular-related hospital readmissions and vital status up to 5 years postdischarge through June 2022 using multivariable-adjusted Cox proportional hazards models.

Hopeful Heart enrolled 756 people with HFrEF (baseline mean age 64.0, 44% female, 73% White race, 28% ± 9.1% mean left ventricular ejection fraction, mean 9-Item Patient Health Questionnaire score 12 ± 5.7, median WS 69 (IQR: 49-88), and median ADI 12 (IQR: 10-15) and followed them for a median of 57.7 months (IQR: 25.0-68.4). Individuals from the least walkable neighborhoods experienced greater 12-month all-cause mortality (HR: 1.70 [95% CI: 1.11-2.61]; P = 0.016), while those from the most deprived neighborhoods had higher 12-month cardiovascular-related hospital readmission (HR: 1.39 [95% CI: 1.09-1.78]; P = 0.008). Neither WS nor ADI predicted 12-month all-cause readmission and cardiovascular-related mortality or 5-year all-cause mortality.

Among recently hospitalized HFrEF patients, neighborhood factors affect 12-month rehospitalization and mortality risk but not 5-year mortality. (Blended Collaborative Care for Heart Failure and Co-Morbid Depression; NCT02044211).