Factors Associated with Heart Failure Self-Care in a Low Socioeconomic Status, Urban Patient Population

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Introduction Patients with low socioeconomic status (SES) have worse heart failure (HF) outcomes than patients with high SES, including higher readmissions. Interventions to improve outcomes in low SES patient populations have not been successful however the reasons remain unclear. Objective To describe the social factors impacting psychological stress and self-care in a low SES patient population with HF and multiple readmissions. Methods In this mixed methods study, 35 subjects with low SES participated in semi-structured interviews about personal and community factors impacting their stress and self-care. Subjects were interviewed during an inpatient readmission for acute decompensated heart failure from two urban hospitals in Chicago. Subjects completed standardized instruments measuring psychological stress (PSS-10), and self-care (SCHFI). Subjects were categorized into high stress (PSS-10 >20) and moderate/low stress (PSS-10 Results Ninety one percent of subjects were African American and 91% were from neighborhoods with high rates of poverty and violence according to US Census data. Subjects experienced a range of admissions (2–12) within the previous 180 days of the current HF admission. Across all three SCHFI sub-scales, the majority of scores were 20 (PSS-10 (14.9 [8.2]). The overarching qualitative theme was that social factors and psychological stress influence self-care. Subjects described the following events as stressful and impacting their self-care: financial difficulties, concern for children/grandchildren's safety, personal health, past impactful deaths, and a recent stressful event. Among subjects whose PSS-10 scores were Conclusion Social factors and psychological stress has impacted the ability of this low SES patient population to perform adequate HF self-care. Research to develop and test sensitive interventions that address social determinants influencing self-care are needed since low SES patient populations continue to experience poorer outcomes.