National Heart Centre Singapore (T.-H.K.T., W.T.T., W.O., C.C., W.H., J.Y., J.T., C.S.P.L.).
Duke-National University of Singapore Medical School (T.-H.K.T., J.T., C.S.P.L.).
Circ Cardiovasc Qual Outcomes. 2021 Apr;14(4):e006962. doi: 10.1161/CIRCOUTCOMES.120.006962. Epub 2021 Mar 24.
Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia.
We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure).
Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (<US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status ( <0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions.
These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov; Unique Identifier: NCT01633398.
关于社会经济因素对亚洲射血分数降低的心力衰竭患者使用基于证据的治疗方法和结局的影响知之甚少。
我们研究了患者层面（家庭收入、教育水平）和国家层面（世界银行分类的区域收入水平、基尼指数表示的收入差距）的社会经济指标与指南指导的治疗方法和临床结局（1 年死亡率或心力衰竭住院的复合结局，生活质量）的相关性，研究对象来自前瞻性多国亚洲心力衰竭（亚洲心力衰竭中的心脏性猝死）研究。
在 4540 例射血分数降低的心力衰竭患者中（平均年龄：60±13 岁，23%为女性），39%居住在低收入地区；34%居住在收入差距较大（基尼系数≥42.8%）的地区；64.4%的家庭月收入较低（<1000 美元）；29.5%的人没有/只有小学教育。在不同区域收入水平下，β受体阻滞剂和器械治疗的治疗差异最大，与来自高收入地区的患者相比，来自低收入地区的患者不太可能接受这些治疗，而且在每个区域收入阶层中，教育程度较低和家庭收入较低的患者之间的差异更大。较高的国家和患者层面的社会经济指标与较高的生活质量评分和较低的主要复合结局风险相关。值得注意的是，我们发现区域收入水平与家庭收入和教育程度之间存在显著的相互作用（两者均<0.001），在高收入地区，家庭收入和教育程度较低与较差的结局之间的关联比在低收入地区更为显著。
这些发现强调了亚洲心力衰竭患者中社会经济决定因素的重要性，并表明应注意解决贫困人口和受教育程度较低者（包括来自富裕地区的人）获得医疗保健方面的差距。注册：网址：https://clinicaltrials.gov；唯一标识符：NCT01633398。
