There’s no place like home for raising risk of re-hospitalization for heart failure

A heart failure patient’s neighborhood can impact the risk of hospital readmissions, a study by Yale investigators reveals in a recent issue of the journal Circulation: Cardiovascular Quality and Outcomes.

Neighborhood characteristics such as noise, air pollution, crime, and access to healthy foods and exercise facilities are tied to neighborhood socioeconomic status (SES). “The association between neighborhood SES and outcomes of patients with heart disease has been under investigation for two decades,” said lead author Dr. Behnood Bikdeli, a research scholar at Yale Center for Outcomes Research and Evaluation (CORE) and a second-year internal medicine resident at Yale-New Haven Hospital. “However, the central question has been whether low neighborhood SES represents as a marker of higher risk, or is independently associated with higher risk of adverse outcomes.”

Bikdeli and colleagues studied over 1,500 patients with heart failure and found that low neighborhood SES was linked to higher rates of hospital readmissions for all causes six months after initial hospital admission. Bikdeli said this is not surprising because prior studies had shown similar findings, but the Yale team’s study focused on information about individual demographics, clinical characteristics, co-morbidities, medications, and individual SES.

“We demonstrated that the impact of neighborhood of residence persisted even after stepwise adjustments for all individual-level factors,” said Bikdeli. “In a broader sense, our study highlights that a wide array of factors that may impact disease outcomes. Although there may be some interrelation between individual and neighborhood characteristics, we believe that individual factors and neighborhood-level factors, can independently impact the outcomes of patients with chronic conditions such as heart failure.”

Bikdeli said a crucial next step in the research is to test whether changing the modifiable neighborhood characteristics would help improve patient outcomes. “In order to prevent readmission, we may need to focus on neighborhood factors, as well as individual patient factors,” he said.

The study was published in Circulation: Cardiovascular Quality and Outcomes. Other authors on this article include Dr. Brian Wayda, Haikun Bao, Dr. Joseph Ross, Xiao Xu, Dr. Sarwat Chaudhry, Dr. John Spertus, Dr. Susannah Bernheim, Dr. Peter Lindenauer, and Dr. Harlan Krumholz.

Citation: Circ. Cardiovasc. Qual. Outcomes doi: 10.1161/CIRCOUTCOMES.113.000911