Social Determinants of Health and Outcomes in Hospitalized Patients with Heart Failure With Preserved Ejection...

Social determinants of health (SDoH) have had limited study in heart failure with preserved ejection fraction (HFpEF). We examined their association with readmission and mortality in a large health care system. Studies that examine the impact of SDoH in HFpEF are limited. We described SDOH affecting outcomes in patients with HFpEF.

In a retrospective study, we analyzed patients admitted to University of Pittsburgh Medical Center hospitals with a primary diagnosis of heart failure from 2010 to 2025. Patients had a left ventricular ejection fraction ≥50% documented on at least 2 echocardiograms. The outcomes were readmissions for heart failure (HF), all-cause readmissions, and mortality. Primary SDoH variables were race, rurality, Area Deprivation Index (ADI), and type of insurance. Covariates included age, sex, race, ADI, insurance type, rurality, length of stay, left ventricular ejection fraction, and comorbidities. The cohort had a median follow-up of 2.69 years.

We identified 54,772 individuals in our cohort with the (mean ± standard deviation) age of 74.8 ± 13.1 years; 57.3% were female and 8.9% were Black. Multivariable Cox regression analysis revealed no differences in outcomes across ADI quartiles. Compared with Medicaid, patients with commercial insurance had lower readmissions for HF (hazard ratio [HR] 0.79, confidence interval [CI] 0.74-0.85, P < .0001), all-cause readmissions (HR 0.80, CI 0.76-0.85, P < .001), and mortality (HR 0.71, CI 0.66-0.77, P < .001). Medicare had greater all-cause readmissions (HR 1.10, CI 1.05-1.16, P < 0.001) compared with Medicaid but similar readmissions for HF (HR 1.04, CI 0.98-1.10, P = .185) and mortality (HR 1.01, CI 0.94-1.08, P = .782). Black patients had greater rates of HF (HR 1.18, CI 1.13-1.23, P < .001) and all-cause readmissions (HR 1.17, CI 1.13-1.21, P < .001). Restricted mean survival time over 10 years was greater in Black patients versus White patients (5.89 years [CI 5.73-6.06] vs 5.72 years [CI 5.61-5.83]; P = .027). Living in rural areas was associated with decreased HF (HR 0.92, CI 0.89-0.95, P < .001), all-cause readmissions (HR 0.90, CI 0.87-0.92, P < .001), and mortality (HR 0.93, CI 0.90-0.96, P = .015) compared with living in urban areas.

In a cohort of patients with HFpEF at a large multihospital system, medical insurance, rurality, and race were related to outcomes whereas ADI did not have a significant association.