Background: Heart failure affects millions of people worldwide and remains a significant health burden. Although there are great advances in Goal Directed Medical Therapy, the 30-day readmission rates for Acute Decompensated Heart Failure (ADHF) remain high with global estimates around 13.2%. Socioeconomic and non-medical factors, evaluated through the Social Determinants of Health (SDOH), play a major role. Social circumstances such as low income, limited education, housing instability, poor health literacy, and food insecurity, are underrecognized factors that impair medication adherence, follow-up, and self-care, driving worse outcomes. In US studies, up to 22–25% of heart failure patients are readmitted within 30 days, and SDOH such as food insecurity have been shown to double readmission risk. This study aims to evaluate how certain Social Determinants of health affect the 30-day readmission rate for acute Congestive Heart Failure Decompensation in a safety-net hospital in South Bronx, NY.
Methods: We conducted a retrospective single-center study of patients admitted with ADHF from February to September 2025 as part of a quality improvement initiative aimed at reducing 30-day readmissions. We evaluated the presence of SDOH among the patient population, stratifying factors such as financial insecurity, housing instability, transportation barriers, food insecurity, and homelessness. Associations with active tobacco use, alcohol use, and other substance use disorders were also assessed. Fisher’s exact test was used to evaluate associations, and p-values < 0.05 were considered statistically significant.
Results: Among the 167 patients included in the study, 53% were 65 years or older, 62% were male, and the primary languages spoken were English (66%) and Spanish (31%). The results demonstrated that patients with social determinants of health (SDOH) had nearly twice the odds of 30-day readmission compared with those without SDOH (OR 1.98), although this association was not statistically significant (p = 0.061).Financial insecurity (OR 1.81, 95% CI 0.54–6.02, p = 0.33), housing instability (OR 1.91, 95% CI 0.89–4.09, p = 0.095), homelessness (OR 2.91, 95% CI 0.39–21.49, p = 0.28), transportation barriers (OR 2.17, 95% CI 0.64–7.36, p = 0.21), and food insecurity (OR 3.03, 95% CI 0.71–12.88, p = 0.12) were each associated with higher odds of readmission; however, none of these associations were statistically significant.In contrast, active smoking was significantly associated with nearly three-fold higher odds of 30-day readmission (OR 2.85, 95% CI 1.40–5.81, p = 0.003). Alcohol use and substance use did not show statistically significant associations with readmission (OR 1.85, 95% CI 0.90–3.79, p = 0.093; OR 1.77, 95% CI 0.87–3.61, p = 0.11, respectively).
Conclusions: In spite of advances in HF treatment, the morbidity and mortality from HF has continued to remain high among Black and Hispanic American patients, likely due to the environmental and socioeconomic challenges they face. Addressing health inequities due to SDoH and substance use meaningfully by implementing Minimally Disruptive Medicine (MDM) tailoring treatment to the patient’s daily life, and reducing their Burden of Treatment will help provide patient centered equitable healthcare.