Background: Racial and ethnic disparities in heart failure (HF) care and outcomes occur, despite rapid improvement in HF therapies and survival [1,2]. The Burden of Treatment Theory is a framework for illustrating and explaining how interactions between patients, healthcare systems, and support networks affect their ability to manage a chronic illness, including HF [3]. We aim to understand the impact of social determinants of Health (SDoH), Burden of Treatment (BoT), and Health-related Quality of Life (QoL) among hospitalized patients with HF.
Methods: Consenting hospitalized HF patients completed a survey addressing SDoH and BoT using the Patient Experience with Treatment and Self-management (PETS), assessing domains like understanding medical information, medication management, appointments, health monitoring, interpersonal challenges, expenses, healthcare service difficulties, role/social limitations, and self-care impact. Patient characteristics, such as demographics and heart failure type, were obtained from chart review. Conditional models used rate ratios, comparing items endorsed to a reference group (male, black, no substance use, reduced EF, high school education, household income >35K).
Results: 265 patients hospitalized from March 2022 to September 2023 were included. The mean age was 66 years with 68% male, 56% Black and non-Hispanic, 20% with substance use, 20% with alcohol use disorder, and 14% with psychiatric illness. The average number of comorbidities per patient was 4.88.42% of the cohort were predominantly black (p=0.007) and had less than high school education and lower mean age (60 yrs vs 64 yrs, p=0.003). SDoH were significantly higher among patients with high school education (p< 0.001). The BoT domains including difficulty with medical information (p=0.015), and healthcare expenses (p=0.019) were higher in patients with more than high school education.Rate ratios >1 symbolize a higher rate of endorsing burden items when compared to the reference group, suggesting harmful effects were significant among Hispanics and patients with HFpEF in the domain of self-care affecting the role and social activity. Similarly, understanding medical information was significantly associated with a rate ratio >1 in patients with less than high school education and annual income < 35K. A higher burden was significantly associated (p< 0.05) in domains including difficulty with monitoring health, medical information, medical expenses, accessing healthcare expenses, self-care causing exhaustion, and difficulty with appointments among patients with social determinants of health. Similarly, higher burdens due to self-care affecting social obligations, role, and social activity, medication bother, difficulty with medical information, appointments, and self-care exhaustion were significantly associated with poorer QoL (p< 0.05).
Conclusions: Current healthcare systems and guidelines are inadequate to adapt care for the large and growing number of patients from racial/ethnic minorities who have complex care needs, multiple comorbidities, and worse SDoH. Integrating BoT measures in healthcare supports a transition to a model that prioritizes quality and efficacy while minimizing disruption to patients. Innovative interventions addressing SDOH are critically needed to bridge racial/ethnic disparities, increase dissemination and implementation of preventive and therapeutic measures, and collectively improve the health and longevity of patients with HF.