Objective To characterise the association between socioeconomic deprivation and adverse outcomes in patients with chronic heart failure (CHF).
Methods We prospectively observed 1802 patients with CHF and left ventricular ejection fraction (LVEF) ≤45%, recruited in four UK hospitals between 2006 and 2014. We assessed the association between deprivation defined by the UK Index of Multiple Deprivation (IMD) and: mode-specific mortality (mean follow-up 4 years); mode-specific hospitalisation; and the cumulative duration of hospitalisation (after 1 year).
Results A 45-point difference in mean IMD score was noted between patients residing in the least and most deprived quintiles of geographical regions. Deprivation was associated with age, sex and comorbidity, but not CHF symptoms, LVEF or prescribed drug therapy. IMD score was associated with the risk of age-sex adjusted all-cause mortality (6% higher risk per 10-unit increase in IMD score; 95% CI 2% to 10%; P=0.004), and non-cardiovascular mortality (9% higher risk per 10-unit increase in IMD score; 95% CI 3% to 16%; P=0.003), but not cardiovascular mortality. All-cause, but not heart failure-specific, hospitalisation was also more common in the most deprived patients. Overall, patients spent a cumulative 3.3 days in hospital during 1 year of follow-up, with IMD score being associated with the age-sex adjusted cumulative duration of hospitalisations (4% increase in duration per 10-unit increase in IMD score; 95% CI 3% to 6%; P<0.0005).
Conclusions Socioeconomic deprivation in people with CHF is linked to increased risk of death and hospitalisation due to an excess of non-cardiovascular events.
- heart failure
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Contributors KKW collected data and contributed to drafting of the manuscript. PAP, AMNW, MD, AS, RB, LCK and RJS collected data and critically revised the manuscript. CBS performed statistical analysis and critically revised the manuscript. MTK collected data, designed the study and contributed to drafting of the manuscript. RMC collected data, designed the study, performed statistical analysis and contributed to drafting of the manuscript. All authors read and approved the final manuscript.
Funding British Heart Foundation project grant (PG/08/020/24617).
Competing interests KKW and MTK have received unrestricted research grants from Medtronic. KKW has also received honoraria for advisory boards and educational sessions from Medtronic and St Jude Medical, both of whom manufacture and market implantable cardioverter defibrillators. All other authors declare no competing interest.
Ethics approval The Leeds West Research Ethics Committee (07/Q1205/17).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data sets generated and/or analysed during the current study are not publicly available due to the use of potentially identifying postal codes in deprivation analyses, but are available from the corresponding author on reasonable request.
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