Impact of social determinants of health on post-hospitalization outcomes and goal-concordant care in patients with advanced heart failure

Background: Social determinants of health (SDoH) influence the advanced illness experience of patients with heart failure (HF). HF is a serious, chronic, and progressive clinical syndrome affecting over 6 million (and rising) adults in the U.S. HF hospitalizations are reported in patients with late-stage, advanced disease and these patients often experience repeat hospitalizations, nearly one-third die within one year following a hospital admission for HF, and almost none survive past two years. This is further exacerbated as HF progresses to an advanced stage, where the general patient preference is to remain at home after being discharged from the hospital after an acute HF incident. While generally accepted that SDoH can be broadly used to identify patients at high risk for worse HF outcomes, what is not yet known is whether any individual SDoH or groups of SDoH are key contributors, or drivers, of adverse health outcomes or readmission after hospital discharge for an acute HF incident, particularly in groups with advanced HF. Therefore, we hypothesize that, by applying a SDoH- -focused lens of analysis to a cohort of patients with advanced HF, we will be able to reveal the individual, systematic, organizational, structural and/or community factors that drive post-hospitalization outcomes, and, ultimately, lead to hospital readmission. Aim 1 Determine the associations between SDoH and the 30- and 90-day post-hospitalization outcomes among patients with advanced (Stage C/D) HF. Aim 2 Identify HF patient perceptions and associated contextual factors of SDoH that influence the achievement of goal-concordant care outcomes among patients with advanced HF living in the community.

Methods: We will conduct a prospective, explanatory sequential mixed-methods study with quantitative and qualitative (quantQUAL) methodologies to contextualize the experiences of patients with advanced HF post-hospitalization. Inclusion criteria: >18 years-old, hospitalized at the study site, diagnosed with advanced (ACCF/AHA Stage C or D) HF, Meta-Analysis Global Group in Chronic Heart Failure Integer risk score >18 (range 0–52). Exclusion criteria: current enrollment in hospice, having a plan for cardiac procedures/surgical therapy within six months, or having a documented non-cardiac terminal illness.

Analysis: For binary readmission outcomes, we will use multivariable logistic analysis to evaluate whether SDoH variables associated with readmissions at 30 and/or 90 days. Qualitative analysis will be conducted on patient interviews with vanManen’s phenomenological approach.

Findings: Findings from this study will further health science by providing the empirical and contextual evidence needed to fill gaps in our understanding about putative SDoH-related individual, systematic, and community-based drivers of post-hospitalization patient-centered HF outcomes in populations with advanced HF.

Grant Number: 7R21NR021061-02
NIH Institute/Center: NIH
Principal Investigator: Kelley Anderson