Population-based evaluation of the impact of socioeconomic status on clinical outcomes in patients with heart failure in integrated care settings
Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved..
INTRODUCTION AND OBJECTIVES: Low socioeconomic status (SES) is associated with poor outcomes in patients with heart failure (HF). We aimed to examine the influence of SES on health outcomes after a quality of care improvement intervention for the management of HF integrating hospital and primary care resources in a health care area of 209 255 inhabitants.
METHODS: We conducted a population-based pragmatic evaluation of the implementation of an integrated HF program by conducting a natural experiment using health care data. We included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January 1, 2015 and December 31, 2019. We compared outcomes between patients exposed to the new HF program and those in the remaining health care areas, globally and stratified by SES.
RESULTS: A total of 77 554 patients were included in the study. Death occurred in 37 469 (48.3%), clinically-related hospitalization in 41 709 (53.8%) and HF readmission in 29 755 (38.4%). On multivariate analysis, low or very low SES was associated with an increased risk of all-cause death and clinically-related hospitalization (all Ps <.05). The multivariate models showed a significant reduction in the risk of all-cause death (HR, 0.812; 95%CI, 0.723-0.912), clinically-related hospitalization (HR, 0.886; 95%CI, 0.805-0.976) and HF hospitalization (HR, 0.838; 95%CI, 0.745-0.944) in patients exposed to the new HF program compared with patients exposed to the remaining health care areas and this effect was independent of SES.
CONCLUSIONS: An intensive transitional HF management program improved clinical outcomes, both overall and across SES strata.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:76 |
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| Enthalten in: |
Revista espanola de cardiologia (English ed.) - 76(2023), 10 vom: 23. Okt., Seite 803-812 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Capdevila Aguilera, Cristina [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 04.10.2023 Date Revised 04.10.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.rec.2023.03.009 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM354687433 |
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| 245 | 1 | 0 | |a Population-based evaluation of the impact of socioeconomic status on clinical outcomes in patients with heart failure in integrated care settings |
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| 500 | |a Date Completed 04.10.2023 | ||
| 500 | |a Date Revised 04.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved. | ||
| 520 | |a INTRODUCTION AND OBJECTIVES: Low socioeconomic status (SES) is associated with poor outcomes in patients with heart failure (HF). We aimed to examine the influence of SES on health outcomes after a quality of care improvement intervention for the management of HF integrating hospital and primary care resources in a health care area of 209 255 inhabitants | ||
| 520 | |a METHODS: We conducted a population-based pragmatic evaluation of the implementation of an integrated HF program by conducting a natural experiment using health care data. We included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January 1, 2015 and December 31, 2019. We compared outcomes between patients exposed to the new HF program and those in the remaining health care areas, globally and stratified by SES | ||
| 520 | |a RESULTS: A total of 77 554 patients were included in the study. Death occurred in 37 469 (48.3%), clinically-related hospitalization in 41 709 (53.8%) and HF readmission in 29 755 (38.4%). On multivariate analysis, low or very low SES was associated with an increased risk of all-cause death and clinically-related hospitalization (all Ps <.05). The multivariate models showed a significant reduction in the risk of all-cause death (HR, 0.812; 95%CI, 0.723-0.912), clinically-related hospitalization (HR, 0.886; 95%CI, 0.805-0.976) and HF hospitalization (HR, 0.838; 95%CI, 0.745-0.944) in patients exposed to the new HF program compared with patients exposed to the remaining health care areas and this effect was independent of SES | ||
| 520 | |a CONCLUSIONS: An intensive transitional HF management program improved clinical outcomes, both overall and across SES strata | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Abordaje de atención al paciente | |
| 650 | 4 | |a Disease management | |
| 650 | 4 | |a Evaluación del resultado de la atención al paciente | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Insuficiencia cardiaca | |
| 650 | 4 | |a Integrated health care systems | |
| 650 | 4 | |a Mejora de la calidad | |
| 650 | 4 | |a Nivel socioeconómico | |
| 650 | 4 | |a Outcomes assessment | |
| 650 | 4 | |a Patient care management | |
| 650 | 4 | |a Prestación integrada de atención en salud | |
| 650 | 4 | |a Quality improvements | |
| 650 | 4 | |a Socioeconomic status | |
| 650 | 4 | |a Tratamiento de la enfermedad | |
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