CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

October 13th, 2014

Heart Failure Readmissions: Neighborhood Factors Matter, Too

For two decades, investigators have been studying the association between neighborhood characteristics and cardiovascular disease. A landmark study from 2001 showed that living in a socioeconomically disadvantaged neighborhood was associated with higher incidence of coronary artery disease. Several studies have also shown an association between neighborhood characteristics, most notably the socioeconomic status (SES) and outcomes of patients with heart failure (HF). Previous studies, however, have not clarified whether neighborhood factors are merely a proxy for individual-level factors or are independent predictors of HF outcomes.

My colleagues and I recently published a study of the association between neighborhood socioeconomic status (SES) and outcomes among 1557 patients from the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial. We found a statistically significant association between low neighborhood SES and higher odds of hospital readmission in patients with HF — an association that, notably, persisted after adjustment for a wide array of individual-level factors such as demographics, comorbidities, therapies, and even individuals’ SES.

I believe that the findings from our study and several others collectively suggest that although individual factors (e.g., patient factors, individuals’ SES, quality of care) and neighborhood factors (e.g., neighborhood SES) might overlap, each of those factors also has some independent correlation with disease incidence and outcomes (see figure by clicking here).

To improve disease outcomes, we may need to focus both on individual factors and on modifiable neighborhood factors, an effort that could require partnership with local governments, business owners, and (most important) residents. It will be crucial to determine whether modifying neighborhood characteristics (e.g., walkability, better access to healthy food, and reducing noise or air pollution) translates into better disease outcomes.

JOIN THE DISCUSSION

Have you encountered patients whose place of residence affected their treatment plan, course of therapy, or access to care?

Categories: Heart Failure
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One Response to “Heart Failure Readmissions: Neighborhood Factors Matter, Too”

  1. William Burke, MD says:
    October 15, 2014 at 1:30 am

    Hugh Fulmer, when he was Dean of Primary Care at UMASS in WORCESTER MA, about 30 or 35 years ago did some work around this topic. Last I knew, he was still living in Northboro MA.