title: Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial.
abstract: BACKGROUND
  Recent studies show an association between neighborhood-level measures of socioeconomic status (SES) and outcomes for patients with heart failure. We do not know whether neighborhood SES has a primary effect or is a marker for individual SES.
  
  
  RESULTS
  We used the data from participants of the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, recruited from 33 US internal medicine and cardiology practices and examined the association between neighborhood SES and outcomes of patients with heart failure. We used census tracts as proxies for neighborhoods and constructed summary SES scores that included information about wealth and income, education, and occupation. The primary end points were readmission and all-cause mortality at 6 months. We conducted patient interviews and medical chart reviews to obtain demographic information, clinical factors, therapies, and individual SES. We included 1557 patients: 524, 516, and 517 from low, medium, and high SES neighborhoods, respectively (mean age, 61.1±15.2 years; 42.2% women).Overall, 745 patients (47.8%) had ≥1 readmission and 179 patients (11.5%) died. When compared with patients in high SES neighborhoods, those living in low-SES neighborhoods were more likely to be readmitted (odds ratio, 1.35; 95% confidence interval, 1.01-1.82), but the mortality rates were not significantly different (odds ratio, 0.78; 95% confidence interval, 0.50-1.18). The results were consistent after multivariable adjustments for individual demographics, clinical factors, and individual SES.
  
  
  CONCLUSIONS
  Among patients with heart failure, neighborhood SES was significantly associated with 6-month all-cause readmission even after adjusting for other patient-level factors, including individual SES. Greater number of events and longer follow-up is required to ascertain the potential effect of neighborhood SES on mortality.
  
  
  BACKGROUND
  http://clinicaltrials.gov/. Unique identifier: NCT00303212.
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: Behnood
authors: B
authors: Bikdeli
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: Brian
authors: B
authors: Wayda
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: Haikun
authors: H
authors: Bao
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: Joseph S
authors: JS
authors: Ross
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: Xiao
authors: X
authors: Xu
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: Sarwat I
authors: SI
authors: Chaudhry
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: John A
authors: JA
authors: Spertus
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: Susannah M
authors: SM
authors: Bernheim
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.).
authors: Peter K
authors: PK
authors: Lindenauer
authors: From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (B.B., B.W., H.B., J.S.R., X.X., S.I.C., S.M.B., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (B.B., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (J.S.R., S.I.C., S.M.B.), Department of Obstetrics, Gynecology, and Reproductive Sciences (X.X.), Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (J.A.S.); Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, MA (P.K.L.); Tufts University School of Medicine, Boston, MA (P.K.L.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K., J.S.R.). harlan.krumholz@yale.edu.
authors: Harlan M
authors: HM
authors: Krumholz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004493:Education / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D058996:Quality Improvement; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D013685:Telecommunications; D014481:United States
keywords: heart failure; mortality; patients readmission; residence characteristics; socioeconomic class