Social determinants of health were associated with differences in readmissions and mortality among patients with heart failure with preserved ejection fraction. This retrospective study, published in Journal of Cardiac Failure, evaluated these associations in patients admitted to University of Pittsburgh Medical Center hospitals between 2010 and 2025 with a primary diagnosis of heart failure.
Eligible patients had left ventricular ejection fraction (LVEF) ≥ 50% documented on at least two echocardiograms. Outcomes included heart failure readmissions, all-cause readmissions, and mortality, with a median follow-up of 2.69 years. Social determinants examined included race, rurality, area deprivation index (ADI), and insurance type, with adjustment for demographic and clinical covariates.
The cohort included 54,772 individuals with a mean age of 74.8 ± 13.1 years; 57.3% were female and 8.9% were Black. Multivariable Cox regression analysis showed no significant differences in outcomes across ADI quartiles. Compared with Medicaid, commercial insurance was associated with lower heart failure readmissions (HR, 0.79; 95% CI, 0.74-0.85; p < .0001), all-cause readmissions (HR, 0.80; 95% CI, 0.76-0.85; p < .001), and mortality (HR, 0.71; 95% CI, 0.66-0.77; p < .001). Medicare was associated with higher all-cause readmissions (HR, 1.10; 95% CI, 1.05-1.16; p < .001), but similar heart failure readmissions and mortality.
Black patients had higher heart failure readmissions (HR, 1.18; 95% CI, 1.13-1.23; p < .001) and all-cause readmissions (HR, 1.17; 95% CI, 1.13-1.21; p < .001). Restricted mean survival time over 10 years was higher among Black patients compared with White patients (5.89 vs 5.72 years; p = .027). Rural residence was associated with lower heart failure readmissions (HR, 0.92; 95% CI, 0.89-0.95; p < .001), all-cause readmissions (HR, 0.90; 95% CI, 0.87-0.92; p < .001), and mortality (HR, 0.93; 95% CI, 0.90-0.96; p = .015).
Insurance type, race, and rurality were associated with readmissions and mortality in HFpEF, while ADI was not associated with outcomes.