Neighborhood-Level Socially Determined Vulnerabilities and Outcomes After Heart Failure Hospitalization

Outcomes are poor for older adults following a hospitalization for heart failure (HF). Neighborhood-level socially determined vulnerabilities could contribute to this, but this is not well studied. We aimed to determine associations between neighborhood-level socially determined vulnerabilities (density of clinical treatment facilities, physical activity facilities, and unhealthy food sources) and outcomes following HF hospitalization.

We included 366 Medicare beneficiaries in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort study aged ≥65 years and living in urban areas, who were discharged to home following HF hospitalization between 2003 and 2017. The main exposures were low versus high density (based on median) of clinical treatment facilities, physical activity facilities, and unhealthy food sources within 1 km of each participants' home. The primary outcomes were 90-day and 6-month composite of all-cause mortality or readmission.

Living in an area with high density of unhealthy food sources was associated with a 6-month composite of all-cause mortality and hospitalization (adjusted hazard ratio [aHR], 1.47 [95% CI, 1.09-1.98]). This was largely driven by readmission (aHR, 1.52 [95% CI, 1.12-2.07]). There were no associations between density of clinical treatment or physical activity facilities with outcomes at either time point.

Higher density of unhealthy food sources in a participant's neighborhood environment is associated with worse outcomes after HF hospitalization among older adults living in urban environments. Neighborhood-level interventions, such as those that can mitigate exposure to unhealthy foods, may be important to improve posthospitalization outcomes in people living with HF.