title: Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: findings from the National Heart Failure Project.
abstract: BACKGROUND
  Prior studies have reported conflicting findings concerning the association of socioeconomic status (SES), treatment, and outcomes in patients hospitalized with heart failure (HF).
  
  
  METHODS
  We conducted a retrospective analysis of medical record data from a national sample of Medicare beneficiaries hospitalized with HF between March 1998 and April 1999 (n = 25,086) to assess the association of patient SES, treatment, and outcomes. Patients' SES was designated as lower, lower-middle, higher-middle, and higher using residential ZIP code characteristics. Patients were evaluated for left ventricular systolic function assessment, prescription of angiotensin-converting enzyme inhibitors at discharge, readmission within 1 year of discharge, and mortality within 30 days and 1 year of admission. Hierarchical logistic regression models were used to assess the association of SES, quality of care, and outcomes adjusting for patient, physician, and hospital characteristics.
  
  
  RESULTS
  Lower SES patients (relative risk [RR] 0.92, 95% CI 0.87-0.96) were modestly less likely to have had a left ventricular systolic function assessment, but had a similar adjusted likelihood of being prescribed angiotensin-converting enzyme inhibitors (RR 1.03, 95% CI 0.93-1.11) compared with higher SES patients after multivariable adjustment. Socioeconomic status was not associated with 30-day mortality after multivariable adjustment, but lower SES patients had a higher risk of 1-year mortality (RR 1.10, 95% CI 1.02-1.19) and readmission within 1 year of discharge (RR 1.08, 95% CI 1.03-1.12) compared with higher SES patients.
  
  
  CONCLUSIONS
  Socioeconomic status in patients hospitalized with HF was not strongly associated with quality of care or 30-day mortality. However, the increased risk of 1-year mortality and readmission among patients of lower SES suggest SES may influence outcomes after hospitalization for HF.
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8088, USA. saif.rathore@yale.edu
authors.forename: Saif S
authors.initials: SS
authors.lastname: Rathore
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: JoAnne M
authors.initials: JM
authors.lastname: Foody
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012923:Social Class; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D044465:White People
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors