Relationship between the place of living and mortality in patients with advanced heart failure

Miguel-Angel Muñoz,Elena Navas,José-Luis Del Val-Garcia,Raquel Garcia,José-Maria Verdú-Rotellar,Julio Duran

doi:10.1186/s12875-020-01213-x

Abstract

BackgroundSocial and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease.MethodsPopulation-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least 1 year after reaching New York Heart Association IV functional class, between 2010 and 2014.Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality.ResultsMean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged > 74 years (p = 0.036), and presented lower comorbidity. Mortality percentages were 59 and 51% among rural and urban patients, respectively (p = 0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend < 0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34–1.90), older patients (HR 1.05, 95% CI 1.04–1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11–1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk.ConclusionsLiving in rural areas determines an increased risk of mortality in patients at final stages of heart failure.

Highlights

Social and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease
Patients classified as New York Heart Association (NYHA) functional class III/IV present almost four-fold greater rates of mortality, and up to 58.3% of NYHA functional class IV dies after a five-year follow-up [10, 11]
When analyzing sociodemographic variables related to mortality we found that being men, older, living in rural areas and having unfavorable housing conditions were related to higher probability of dying, but no significant differences were found among urban patients regarding the area where they lived

Summary

Introduction

Social and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. According to data published by the World Bank, the percentage of rural populations fluctuates from 19 to 59% depending on the degree of development of the countries in question [1]. Whilst the HF incidence rate has declined in recent years, its prevalence has increased, suggesting that survival over time is longer, probably due to better care and treatment [7]. This improvement in survival is modest [8], and research in HF is considered one of the most important priorities [9]. Due to its irregular evolution, HF is not usually considered a terminal disease, whilst at advanced stages it could be compared to malignant neoplasms [12]

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