Abstract 2381: Socioeconomic Status is Associated with Increased Morbidity in Patients Enrolled in a Dedicated Heart Failure Program

Despite continued advances in medicine, the NIH has reported that differences in the incidence, prevalence, and burden of diseases persist between socioeconomic classes. Heart failure (HF) is the leading cause of hospitalizations in all patients over the age of 65. The effect of socioeconomic disparities on this major cause of morbidity has not been well studied. A retrospective analysis was performed on 500 patients with heart failure followed in the University of Illinois-Chicago heart failure clinic from 1/1/2000 –1/1/2008. Patients were stratified by household income and education level by correlating patient zip codes with the 2000 U.S. Census Data. The primary endpoint was admission for HF exacerbation. In patients with established HF, patients living in areas with lower median household incomes were significantly more likely to have a HF exacerbation (P = 0.006), as well as an increase in total exacerbations (P = 0.005) through an average follow up period of 5.2 years. The same trend was observed when areas were stratified according to the percentage of population with bachelor’s degrees. Overall, baseline characteristics were similar between groups. Significant differences by household income and education level were found in hypertension, presence of coronary artery disease and medication use (Tables 1 and 2 ). Despite uniform treatment according to ACC/AHA guidelines, socioeconomic disparities were associated with increased morbidity in patients established in a dedicated heart failure program. Further studies are needed to address these disparities. Heart Failure Outcomes by Median Household Income Heart Failure Outcomes by Education

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Abstract 280: Association of Bystander CPR Rates with County-Level Median Household Income in Pennsylvania

Circulation ◽

10.1161/circ.130.suppl_2.280 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kam Ching Li ◽

Julie E Griff ◽

Elizabeth K Heisler ◽

Anne V Grossestreuer ◽

Marion Leary ◽

...

Keyword(s):

Cardiac Arrest ◽

Population Density ◽

Household Income ◽

Census Data ◽

Education Level ◽

County Level ◽

Median Household Income ◽

Related Factors ◽

Poverty Status ◽

Bystander Cpr

Background: Each year, >300,000 people suffer from out-of-hospital cardiac arrest (OHCA) in the U.S. Studies have shown that bystander CPR (BCPR) can greatly increase a victim’s chance of survival, yet the frequency of BCPR may vary as a byproduct of various demographic factors. Over 10,000 OHCAs occur in Pennsylvania each year across 67 counties. Objective: We sought to determine the association of bystander CPR rate with county-level median household income, as well as related factors, such as education level, persons below poverty status, and population density. Methods: Data were obtained from the Cardiac Arrest Registry to Enhance Survival (CARES) for Pennsylvania from 1/2012-12/2013 to determine rate of BCPR and return of spontaneous circulation (ROSC) by county. Demographic information regarding education level, median household income and population density were obtained from 2010 U.S. Census data. Counties were grouped into quartiles by lowest to highest rates of BCPR. Results from the lowest-performing were compared to the highest-performing quartile, with statistical analysis using STATA v11 (StataCorp, College Station, Texas). Results: A total of 7137 cases were included distributed across 47 counties. Mean age of patients was 63.7 years, 40.1% were female, and VF/VT was the initial rhythm in 19.7%. Median BCPR rate for the lowest-performing quartile was 7% (IQR 0%-26.5%). Median BCPR rate for the highest-performing quartile was 50.4% (IQR 46.95%-56%). Median ROSC rate for the lowest-performing quartile was 1.5% (IQR 0%-20%). Median ROSC rate for the highest-performing quartile was 23.3% (IQR 20.8%-33.3%). Median household income in the lowest-performing quartile was significantly lower than in the highest-performing quartile ($43611 ± $5038 v $50225 ± $6661, p = 0.023). Education level, persons below poverty status, and population density were not shown to have a significant association with BCPR rate. BCPR rate was positively associated with ROSC rate (p=0.001). Conclusions: BCPR rates are significantly higher in counties with higher median household income. Higher BCPR rates are associated with higher rates of ROSC. These findings have important implications for statewide public health efforts to improve arrest survival.

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