Background: The key goals of HF therapy are to prevent progression of symptoms, improve quality of life, and prolong survival. Studies have attempted to study and improve post hospitalization outcomes among patients with HF. Social determinants of Health include a wide set of factors from daily life which are responsible for health inequity. Burden of Treatment (BoT) refers to the imbalance between treatment related workload placed on patients by the health care system and the patients’ capacity to engage in additional self-care.
Methods: Consenting patients hospitalized with HF exacerbation were included in the study from March 2022. Baseline characteristics were collected by chart review. BoT was assessed with the Patient Experience with Treatment and Self management (PETS) tool consisting of 9 dimensions (48 items) assessing the burden from chronic illness treatment and self-care experienced in the last four weeks including: medical information, medications, medical appointments, monitoring health, relationships with others, health care expenses, difficulty with health care services, role and social activity limitations due to self-care, and physical and mental fatigue due to selfcare. SDoH was evaluated using a questionnaire assessing bills and finances, food insecurities, needs for benefits, school, childcare, housing insecurities, housing conditions, immigration needs, social isolation and homelessness. Patients were called at 6 months. Statistical analysis done with frequencies, paired T-test for BoT and McNemar exact for SDoH.
Results: Of the 113 patients enrolled thus far, 74 (65%) had HFrEF and 39(35%) had HFpEF. Mean age was 63 years among HFrEF and 66 in HFpEF (p=0.198) with women predominating HFpEF hospitalizations (p< 0.0001). HTN and Obesity was common among HFpEF while CAD and OSA were in HFrEF. Substance use (alcohol/cocaine/heroin/tobacco) was significantly higher among hospitalized HFrEF compared to HFpEF. SDoH was significant with 84% of HFpEF and 80% of HFrEF patients with high school or lower education, higher food insecurity (26% vs13%), higher housing instability (28% vs 13%) and higher unemployment (81% vs 74%) among HFrEF. With respect to BoT, significantly higher burden in role and social activity limitations (44.5 vs 30.4 p=0.026), difficulty in health care services (30 vs 23.5), monitoring health (31 vs22), medications (19vs 13) and medical information (29 vs 24) were observed in HFpEF compared to HFrEF. Of the eligible 42 patients for 6 months follow up,20 (6 HFpEF and14 HFrEF) responded. we observed that HFrEF patients improved in most domains for BoT except health monitoring and physical exhaustion. The domain most improved were medical information, medical expenses and difficulty with healthcare services (mean difference between initial and follow up -19%, -18%,-18%, respectively).Among HFpEF we observed, worsening in all domains especially role and social activity limitations and physical and mental exhaustion (27%, 16% mean difference respectively).No changes in SDoH were observed on 6 months follow up.
Conclusions: The impact of SDoH and substance use among these patients is significant testament to their role in contributing to disparities in this population. With HFpEF hospitalizations more common in women, the higher overall burden of treatment and lack significant improvement on 6 month followup among these patients identifies potential areas of intervention to improve outcomes, albeit further follow up is required to understand this further.