Abstract 17315: Black Patients With Heart Failure Living in Distressed Communities Disproportionately Experience Excess Risk of Mortality After Emergency Department Visit for Dyspnea

Abstract

Introduction: Dyspnea is a frequent reason for seeking emergency care in patients with heart failure (HF). Social determinants of health play an important role in long term survival in this population. We sought to explore the association between community’s economic well-being and post-visit survival in patients with HF evaluated in the emergency department (ED) for dyspnea. Methods: This was a retrospective cohort study enrolling all consecutive patients with a history of HF and an ED visit for a chief complaint of dyspnea at one of 40 UPMC-affiliated hospitals in Western PA between 1/2018 and 12/2021. We automatically extracted limited tabular data from electronic health records (e.g., demographics, visit dates) and performed manual chart review to determine home community status according to Economic Innovation Group’s Distressed Communities Index (i.e., prosperous/comfortable vs mid-tier/at-risk/distressed). Primary outcome was all cause death, established by documented death in UPMC network inpatient or outpatient charts and through a manual obituary search to ascertain missing death dates through 5/2023. We used Cox regression to identify independent predictors of time-to-event (death) and plotted significant predictors using Kaplan-Meier analysis. Results: The sample included 1248 patients (age 73 ± 13, 53% female, 15% Black). Around 59% of patients lived in distressed communities, and 62% died during a mean follow up of 996 days. In multivariate Cox regression, age (HR=1.032, 95% CI 1.025-1.038) and non-Black race (HR=2.304, 95% CI 1.264-4.202) were associated with excess risk of mortality. There was a significant independent interaction between race and residence, with Black individuals living in distressed communities experiencing excess risk of death compared to their counterparts (HR=1.926, 95% CI 1.083-3.424). This interaction was not evident among individuals who were not Black. Conclusion: While elderly patients, who are predominantly White, experience excess risk of HF mortality irrespective to area of residence, Black patients living in distressed communities experience excess risk of mortality, independent of age, sex, and other potential risk factors.