Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK.
Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Heart. 2018 Jun;104(12):993-998. doi: 10.1136/heartjnl-2017-312539. Epub 2018 Jan 31.
To characterise the association between socioeconomic deprivation and adverse outcomes in patients with chronic heart failure (CHF).
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).
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).
Socioeconomic deprivation in people with CHF is linked to increased risk of death and hospitalisation due to an excess of non-cardiovascular events.
描述慢性心力衰竭（CHF）患者社会经济剥夺与不良结局之间的关系。
我们前瞻性观察了 2006 年至 2014 年间在英国四家医院招募的 1802 名 LVEF≤45%的 CHF 患者。我们评估了英国多因素剥夺指数（IMD）定义的剥夺与以下方面的关联：特定模式的死亡率（平均随访 4 年）；特定模式的住院治疗；以及住院治疗的累计持续时间（1 年后）。
居住在地理区域最贫困和最富裕五分位数的患者之间，平均 IMD 评分相差 45 分。剥夺与年龄、性别和合并症有关，但与 CHF 症状、LVEF 或规定的药物治疗无关。IMD 评分与年龄性别调整后的全因死亡率风险相关（IMD 评分每增加 10 个单位，风险增加 6%；95%CI 2%至 10%；P=0.004），与非心血管死亡率风险相关（IMD 评分每增加 10 个单位，风险增加 9%；95%CI 3%至 16%；P=0.003），但与心血管死亡率风险无关。最贫困的患者也更常见全因住院治疗，但不是心力衰竭特异性住院治疗。总体而言，患者在 1 年随访期间累计住院 3.3 天，IMD 评分与年龄性别调整后的住院累计持续时间相关（IMD 评分每增加 10 个单位，持续时间增加 4%；95%CI 3%至 6%；P<0.0005）。
CHF 患者的社会经济剥夺与因非心血管事件导致的死亡和住院风险增加有关。
