It’s local: Heart failure outcomes linked to neighborhood

Neighborhood effects may have an influence on readmissions in patients with heart failure. Whether or not patients themselves have a higher socioeconomic status (SES), where they live may play a role in their post-release outcomes, according to a study published online July 29 in Circulation: Cardiovascular Quality & Outcomes.

Behnood Bikdeli, MD, of Yale-New Haven Hospital in Connecticut, and colleagues explored this dynamic as part of the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial. They enrolled 1,557 patients and divided them into three relatively equal groups based on living situation, as determined by census maps. Patients who lived in low SES neighborhoods comprised 33.7 percent of patients; 33.1 percent of patients lived in middle SES neighborhoods and 33.2 percent of patients lived in high SES neighborhoods.

While 40 percent of patients living in low SES neighborhoods reported making less than $10,000 a year, 15.2 percent of patients living in high SES neighborhoods reported the same. In contrast, 20.4 percent of those living in high SES neighborhoods and 1.5 percent of those living in low SES neighborhoods reported making more than $70,000 a year.

When comparing socioeconomic neighborhoods, Bikdeli et al found that neighborhoods on the low end of the scale had a 7.2 percent higher likelihood of readmission one or more times in the subsequent six months to initial hospitalization for heart failure. Composite results of death and readmission placed 1.46 odds in low SES neighborhoods when demographics were put into play.

No statistically significant difference was seen between the three types of neighborhoods and death as a singular endpoint.

Past research has linked neighborhoods with outcomes for obesity and other cardiovascular disease without taking into account the individual. However, this research suggests that even if the individual’s own SES is factored in, the neighborhood’s status plays a far greater role. The patient may be able to afford access to healthy foods, better healthcare and access to a gym or safe, healthy walking environment, but if none of these are available in the immediate area, there is, essentially, no access.

“The intent of our study was to determine the association between neighborhood characteristics and outcomes of patients with heart failure and to see if such associations are, at least in part, independent of individual SES,” wrote Bikdeli et al. “Our findings confirmed such associations.”

They added that characteristics that may be part of why a neighborhood influences health outcomes included but were not limited to food deserts (i.e., places where healthier food options were unavailable), lack of safe exercise space (parks or facilities), environmental stress (including air and noise pollutants), lack of ready access to quality healthcare, lesser support systems (e.g. familial, cultural, etc.) and access to and advertising for tobacco and alcohol.

Bikdeli et al recommended that future research explore how these neighborhoods can be changed to provide better outcomes for all patients, especially those with heart failure.