Socioeconomic factors and mortality in diastolic heart failure.
BACKGROUND
Mortality in patients with heart failure with preserved ejection fraction (HFPEF) has remained stable over recent decades. Few studies have explored prognostic characteristics specifically in HFPEF, and none of them has assessed the potential impact of socioeconomic factors. We aimed to evaluate the impact of socioeconomic factors on all-cause and cardiovascular mortality in HFPEF patients.


METHODS
We used data from the French ODIN cohort. All patients with heart failure and a left ventricular ejection fraction (LVEF) > 45%, included in ODIN between July 2007 and July 2010, were eligible here. Socioeconomic, demographic, clinical, biological and therapeutic data were collected at inclusion. The endpoints were all-cause and cardiovascular mortality between inclusion and 30 September 2011. The impact of patient socioeconomic characteristics on mortality was assessed using Cox regression models.


RESULTS
Of 575 HFPEF patients considered, 58·6% were male; their mean age was 71·1 ± 13·5 years, and their mean LVEF was 58·1 ± 8·5%. After adjustment for confounders, living alone and limitations on activities of daily living were associated with all-cause mortality [HR = 1·77, 95%CI(1·11-2·81) and 2·61(1·35-5·03), respectively] and cardiovascular mortality [2·26 (1·24-4·10) and 3·16 (1·33-7·54), respectively]. Having a professional occupation was associated with a lower cardiovascular mortality only [0·37(0·15-0·94)].


CONCLUSIONS
Poor social conditions impair survival in patients with HFPEF. These findings may shed new light on how best to detect HFPEF patients with high health-care needs.
INSERM, CIC-EC, CIE6, Nancy, France; CHU Nancy, Epidémiologie et Evaluation Cliniques, Nancy, France; Université de Lorraine, Université Paris Descartes, APEMAC, EA, Nancy, France.
Matthieu
M
Schockmel
Nelly
N
Agrinier
Patrick
P
Jourdain
François
F
Alla
Jean-Christophe
JC
Eicher
Patrice
P
Coulon
Justine
J
Druelle
Geneviève
G
Mulak
Nicolas
N
Danchin
Nathalie
N
Thilly
Yves
Y
Juillière
D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D054144:Heart Failure, Diastolic / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D012847:Single Person; D012959:Socioeconomic Factors; D013318:Stroke Volume / Q000502:physiology
Activities of daily living; all-cause mortality; cohort study; heart failure with preserved ejection fraction; living alone; socioeconomics factors