title: Socioeconomic and partner status in chronic heart failure: Relationship to exercise capacity, quality of life, and clinical outcomes.
abstract: BACKGROUND
  Prognosis in patients with heart failure (HF) is commonly assessed based on clinical characteristics. The association between partner status and socioeconomic status (SES) and outcomes in chronic HF requires further study.
  
  
  METHODS
  We performed a post hoc analysis of HF-ACTION, which randomized 2,331 HF patients with ejection fraction ≤35% to usual care ± aerobic exercise training. We examined baseline quality of life and functional capacity and outcomes (all-cause mortality/hospitalization) by partner status and SES using adjusted Cox models and explored an interaction with exercise training. Outcomes were examined based on partner status, education level, annual income, and employment.
  
  
  RESULTS
  Having a partner, education beyond high school, an income >$25,000, and being employed were associated with better baseline functional capacity and quality of life. Over a median follow-up of 2.5 years, higher education, higher income, being employed, and having a partner were associated with lower all-cause mortality/hospitalization. After multivariable adjustment, lower mortality was seen associated with having a partner (hazard ratio 0.91, 95% CI 0.81-1.03, P=.15) and more than a high school education (hazard ratio 0.91, CI 0.80-1.02, P=.12), although these associations were not statistically significant. There was no interaction between any of these variables and exercise training on outcomes (all P>.5).
  
  
  CONCLUSIONS
  Having a partner and higher SES were associated with greater functional capacity and quality of life at baseline but were not independent predictors of long-term clinical outcomes in patients with chronic HF. These findings provide information that may be considered as potential variables impacting outcomes.
authors.affiliation: Washington University School of Medicine, St Louis, MO. Electronic address: amanda.verma@wustl.edu.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Verma
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: University of Alabama, Birmingham, AL.
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.affiliation: Henry Ford Hospital, Detroit, MI.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, MD.
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.affiliation: Montefiore-Einstein Medical Center, New York, NY.
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.affiliation: University of Louisville, Louisville, KY.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Swank
authors.affiliation: University of Alabama, Birmingham, AL.
authors.forename: Meredith
authors.initials: M
authors.lastname: Fitz-Gerald
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ellis
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: William E
authors.initials: WE
authors.lastname: Kraus
authors.affiliation: Jefferson Medical College, Philadelphia, PA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012959:Socioeconomic Factors; D018454:Spouses