Larsson Johan E, Kristensen Søren Lund, Deis Tania, Warming Peder E, Schou Morten, Køber Lars, Boesgaard Søren, Rossing Kasper, Gustafsson Finn
Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
ESC Heart Fail. 2025 Feb;12(1):477-486. doi: 10.1002/ehf2.15089. Epub 2024 Sep 30.
Socioeconomic deprivation is a risk marker for worse prognosis in patients with heart failure (HF), and a potential barrier to referral for advanced HF evaluation. The relationship between socioeconomic status (SES) and invasive haemodynamics in patients undergoing evaluation for advanced HF therapies is unknown.
We combined a consecutive clinical registry of patients evaluated for advanced HF with patient-level data on SES (household income, education, workforce status, cohabitant status and distance from home to tertiary HF centre) derived from nationwide registries. Using this information, the cohort was divided into groups of low-, medium- and high degree of socioeconomic deprivation. The associations between SES and invasive haemodynamics were explored with multiple linear regression adjusted for age and sex.
A total of 631 patients were included. The median age was 53 years, and 23% were women. Patients in the highest income quartile versus the lowest (Q4 vs. Q1) were older (median age 57 vs. 50 years) and more often male (83% vs. 67%), both P < 0.001. Increasing household income (per 100 000 Danish kroner,1 EUR = 7.4 DKK) was associated with lower pulmonary capillary wedge pressure (PCWP) [-0.18 mmHg, 95% confidence interval (CI) -0.36 to -0.01, P = 0.036] but not significantly associated with central venous pressure (CVP) (-0.07 mmHg, 95% CI -0.21 to 0.06, P = 0.27), cardiac index (-0.004 L/min/m, 95% CI -0.02 to 0.01, P = 0.60), or pulmonary vascular resistance (PVR) (-0.003 Wood units, 95% CI -0.37 to 0.16, P = 0.84). Comparing the most deprived with the least deprived group, adjusted mean PVR was higher (0.35 Wood units, 95% CI 0.02 to 0.68, P = 0.04), but PCWP (0.66 mmHg, 95% CI -1.49 to 2.82, P = 0.55), CVP (-0.26 mmHg, 95% CI -1.76 to 1.24, P = 0.73) and cardiac index (-0.03 L/min/m, 95% CI -0.22 to 0.17, P = 0.78) were similar.
Most haemodynamic measurements were similar across layers of SES. Nevertheless, there were some indications of worse haemodynamics in patients with lower household income or a high accumulated burden of socioeconomic deprivation. Particular attention may be warranted in socioeconomically deprived patients to ensure timely referral for advanced HF evaluation.
社会经济剥夺是心力衰竭（HF）患者预后较差的风险指标，也是晚期HF评估转诊的潜在障碍。接受晚期HF治疗评估的患者的社会经济地位（SES）与有创血流动力学之间的关系尚不清楚。
我们将连续的晚期HF评估患者临床登记数据与来自全国登记处的患者层面的SES数据（家庭收入、教育程度、劳动力状况、同居状况以及从家到三级HF中心的距离）相结合。利用这些信息，将队列分为社会经济剥夺程度低、中、高的组。采用多线性回归分析探索SES与有创血流动力学之间的关联，并对年龄和性别进行校正。
共纳入631例患者。中位年龄为53岁，23%为女性。收入最高四分位数组与最低四分位数组的患者（Q4与Q1）年龄更大（中位年龄57岁对50岁），男性比例更高（83%对67%），P均<0.001。家庭收入增加（每100,000丹麦克朗，1欧元=7.4丹麦克朗）与较低的肺毛细血管楔压（PCWP）相关[-0.18 mmHg，95%置信区间（CI）-0.36至-0.01，P=0.036]，但与中心静脉压（CVP）无显著关联（-0.07 mmHg，95%CI -0.21至0.06，P=0.27），与心脏指数（-0.004 L/min/m，95%CI -0.02至0.01，P=0.60）或肺血管阻力（PVR）（-0.003 Wood单位，95%CI -0.37至0.16，P=0.84）无关。比较最贫困组与最不贫困组，校正后的平均PVR更高（0.35 Wood单位，95%CI 0.02至0.68，P=0.04），但PCWP（0.66 mmHg，95%CI -1.49至2.82，P=0.55）、CVP（-0.26 mmHg，95%CI -1.76至1.24，P=0.73）和心脏指数（-0.03 L/min/m，95%CI -0.22至0.17，P=0.78）相似。
SES各层次间的大多数血流动力学测量结果相似。然而，有一些迹象表明，家庭收入较低或社会经济剥夺累积负担较高的患者血流动力学较差。对于社会经济贫困患者，可能需要特别关注，以确保及时转诊进行晚期HF评估。
