The Influence of Socioeconomic Status on the Prognosis and Profile of Patients Admitted for Acute Heart Failure during COVID-19 Pandemic: Overestimated Aspects or a Multifaceted Hydra of Cardiovascular Risk Factors?

Radu-Stefan Miftode,Antoniu Octavian Petris,Adrian Crisan,Corina-Maria Cianga,Daniela Constantinescu,Ovidiu Mitu,Irina-Iuliana Costache,Amalia-Stefana Timpau,Petru Cianga,Mihai Stefan Cristian Haba,Ionela-Larisa Miftode,Ionela-Lacramioara Șerban,Celina-Silvia Stafie,Minela-Aida Maranduca

doi:10.3390/healthcare9121700

Radu-Stefan Miftode, Antoniu Octavian Petris + Show 12 more

Open Access

https://doi.org/10.3390/healthcare9121700

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Abstract

Background: Heart failure (HF) is a complex clinical syndrome that represents a great burden on public health systems due to its increased prevalence, disability and mortality rates. There are multiple triggers that can induce or aggravate a preexisting HF, socioeconomic status (SES) emerging as one of the most common modifiable risk factors. Our study aimed to analyze the influence of certain SES indicators on the outcome, clinical aspects and laboratory parameters of patients with HF in North-Eastern Romania, as well as their relationship with other traditional cardiovascular risk factors. Methods: We conducted a prospective, single-center study comprising 120 consecutively enrolled patients admitted for acute HF. The evaluation of individual SES was based upon a standard questionnaire and evidence from official documents. Results: the patients’ age ranged between 18 and 94 years; Out of 120 patients, 49 (40.8%) were women and 71 (59.2%) were men, residing in rural 59 (49.2%) or urban 61 (50.8%) areas. 14.2% were university graduates, while 15.8% had only attended primary school. The majority of the patients are or were employed in the service sector (54.5%), followed by industry (29.2%) and agriculture (20%). The mean monthly income was 306.1 ± 177.4 euro, while the mean hospitalization cost was 2471.8 ± 2073.8 euro per patient. The individual income level was positively correlated with urban area of residence, adequate household sanitation facilities and healthcare access, and negatively associated with advanced age and previous hospitalizations due to HF. However, the individual financial situation was also positively correlated with the increased prevalence of certain cardiovascular risk factors, such as arterial hypertension, anemia or obesity, but not with total cholesterol or male gender. Concerning the direct impact of a poor economic status upon prognosis in the setting of acute HF, our results showed no statistically significant differences concerning the in-hospital or at 1-month follow-up mortality rates. Rather than inducing a direct impact on the short-term outcome, these findings concerning SES indicators are meant to enhance the implementation of policies aimed to provide adequate healthcare for people from all social layers, with a primary focus on modifiable cardiovascular risk factors.

Highlights

The prevalence of heart failure (HF) shows a rising trend globally, as is the number of people presenting with various risk factors that can trigger an acute Heart failure (HF) or decompensate a preexisting one
Our results showed positive and significant correlations between income level and other major cardiovascular risk factors such as tobacco use, arterial hypertension, anemia or increased body mass index (BMI), but not with total cholesterol or male gender
We noticed that certain echocardiographic parameters, with a major role in the prognosis of HF, such as LVEF or sPAP, were correlated with individual income

Summary

Introduction

The prevalence of heart failure (HF) shows a rising trend globally, as is the number of people presenting with various risk factors that can trigger an acute HF or decompensate a preexisting one. From a medical perspective, the financial cost should be a secondary aspect, we still have to consider the economic impact of HF, which is estimated in various recent studies at tens of billions of dollars, with doubled HF-associated costs projected for 2030 [3] It is a source of significant mortality, the incidence and prevalence of HF are directly correlated with the increase in life expectancy among the general population, even more as HF represents the endpoint syndrome of multiple cardiovascular pathologies. Rather than inducing a direct impact on the short-term outcome, these findings concerning SES indicators are meant to enhance the implementation of policies aimed to provide adequate healthcare for people from all social layers, with a primary focus on modifiable cardiovascular risk factors

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