Abstract 14837: Social Determinants of Health and Outcomes in Patients With Advanced Heart Failure: Findings From PAL-HF

Background: Social determinants of health (SDH) are associated with cardiovascular disease outcomes, but the overall influence of SDH on end-stage heart failure has not been well-described. Methods: In the Palliative Care in Heart Failure (PAL-HF) study, 150 advanced HF patients were randomized to usual care or usual care plus palliative care intervention. In the present analysis, quality of life (QoL) metrics [Kansas City Cardiomyopathy Questionnaire (KCCQ) and Functional Assessment of Chronic Illness Therapy (FACIT) Palliative care (PAL)], anxiety and depression (Hospital Anxiety and Depression Scale; HADS Depression, HADS Anxiety) and clinical outcomes (mortality, rehospitalization) were examined based on SDH (marital status, employment status, economic security, education level). For statistical analyses, patients were grouped per independent variable of interest in dichotomous categories (partner vs. no partner, employed/retired vs. unemployed, patient-reported economic constraints vs. no constraints, education beyond high school (HS) vs. less than HS). Repeated measures models were used to compare QoL metrics between SDH groups and Cox models for clinical outcomes. Results: At 6-month follow-up, having a partner, being employed, education beyond HS, and having economic security were not associated with better QoL or anxiety/depression metrics in advanced HF patients. Unemployment and education less than HS were associated with increased 6-month rehospitalization (both p=0.03). SDH measures were not associated with mortality (all p>0.05) (Table). Conclusions: In this analysis of PAL-HF patients, SDH were not associated with improved QoL or anxiety/depression metrics over 6 months. However, being employed and education beyond HS were associated with reduced rehospitalization. Further studies accounting for SDH are needed to better determine how these factors should be incorporated into palliative care interventions in advanced HF.

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Abstract 262: The Impact of Social Determinants of Health on Heart Failure Readmission in a Veteran Population: A Single Center Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.262 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Sunita K Mahabir ◽

Neal Olarte ◽

Ana M Palacio

Keyword(s):

Heart Failure ◽

High Risk ◽

Social Determinants Of Health ◽

Social Determinants ◽

Social Factors ◽

Determinants Of Health ◽

Fiscal Year ◽

Readmission Rates ◽

Validated Questionnaire ◽

The Impact

Background: Chronic heart failure (CHF) affects more than 5 million Americans and accounts for approximately 1 million hospitalizations annually. Readmission in CHF patients is associated with higher mortality and consumes a significant portion of hospital resources. Readmission rates may be higher when socioeconomic factors limit medication compliance and follow-up. In light of the high prevalence of CHF and the penalties associated with readmission rates, our study aims to identify factors that place our veterans with CHF at higher risk for readmission and in so doing, develop a profile for patients with a high risk of readmission that will benefit from focused intervention. Our goal is to use the information acquired in this study to reduce CHF readmission in the Miami VAMC by 10% over a 12-month period. Methods: This is an ongoing retrospective study conducted at the Miami VAMC. The Strategic Analysis for Improvement and Learning (SAIL) report was used to identify patients with CHF who were admitted to the Miami VAMC over fiscal year 2019 (FY19), the period from September 2018 to August 2019. Data was collected on various clinical baseline characteristics and social determinants of health from the patients' electronic health records for those admitted as well as for those with recurrent admissions within FY19. Using a previously validated questionnaire, identified patients will undergo further interview, in person or by phone, to identify social factors that may place them at higher risk for readmission. Results/Anticipated Results: A total of 185 patients were admitted during FY19 and of these, 38 had recurrent admissions. The mean time to readmission was 82 days. 76% of the patients readmitted had heart failure with reduced ejection fraction. Multiple co-morbidities were seen in the readmitted group, the commonest being hypertension (82%), diabetes (63%) and chronic kidney disease (39%). Thirty percent of those readmitted had a history of illicit drug use compared to 26% of those who were not readmitted. This population was also found to have multiple psychiatric co-morbidities - depression, anxiety and post-traumatic stress disorder. The odds of having one or more readmission within 12 months was 25% greater in those with psychiatric illness than in those without. Conclusion: Preliminary data analysis shows that psycho-social factors may play a role in recurrent admission in CHF patients. Further data will be collected to determine the impact of factors such as housing, education level and income on readmission risk so that patients at high risk can be identified and targeted with improved care co-ordination services to reduce this risk. As a unified health system, the VAMC is uniquely equipped with resources to address these disparities.

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EFFECTS OF SOCIAL DETERMINANTS OF HEALTH ON CLINICAL OUTCOMES AFTER STEMI: THE LOMA LINDA EXPERIENCE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)30761-0 ◽

2020 ◽

Vol 75 (11) ◽

pp. 134

Author(s):

Michael Lawrenz Co ◽

Yong Ji ◽

Andrew Hong ◽

Anthony A. Hilliard

Keyword(s):

Social Determinants Of Health ◽

Clinical Outcomes ◽

Social Determinants ◽

Determinants Of Health

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Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000767 ◽

2020 ◽

Vol 141 (22) ◽

Cited By ~ 7

Author(s):

Connie White-Williams ◽

Laura P. Rossi ◽

Vera A. Bittner ◽

Andrea Driscoll ◽

Raegan W. Durant ◽

...

Keyword(s):

Heart Failure ◽

Social Determinants Of Health ◽

Social Determinants ◽

Healthcare Providers ◽

Clinical Syndrome ◽

Assessment Tools ◽

Determinants Of Health ◽

Number Of Patients ◽

Patients With Heart Failure ◽

Scientific Statement

Heart failure is a clinical syndrome that affects >6.5 million Americans, with an estimated 550 000 new cases diagnosed each year. The complexity of heart failure management is compounded by the number of patients who experience adverse downstream effects of the social determinants of health (SDOH). These patients are less able to access care and more likely to experience poor heart failure outcomes over time. Many patients face additional challenges associated with the cost of complex, chronic illness management and must make difficult decisions about their own health, particularly when the costs of medications and healthcare appointments are at odds with basic food and housing needs. This scientific statement summarizes the SDOH and the current state of knowledge important to understanding their impact on patients with heart failure. Specifically, this document includes a definition of SDOH, provider competencies, and SDOH assessment tools and addresses the following questions: (1) What models or frameworks guide healthcare providers to address SDOH? (2) What are the SDOH affecting the delivery of care and the interventions addressing them that affect the care and outcomes of patients with heart failure? (3) What are the opportunities for healthcare providers to address the SDOH affecting the care of patients with heart failure? We also include a case study ( Data Supplement ) that highlights an interprofessional team effort to address and mitigate the effects of SDOH in an underserved patient with heart failure.

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