Abstract 14149: Neighborhood Income and Heart Failure Outcomes: A Nationwide Retrospective Cohort Analysis

Introduction: The association between socioeconomic status (SES) and heart failure (HF) outcomes is not well understood.

Methods: We conducted a retrospective analysis of adult HF hospitalizations from the United States National Inpatient Sample (NIS) between 2016 - 2020. Quartile classification of the median household income of the zip code of the patient’s residence provided by NIS was used. Multivariable logistic regression, adjusting for multiple variables (Table 1), was performed.

Results: From lowest to highest income quartile, mean age and proportion of White race increased; proportion of females, Black, and Hispanic race decreased (Table 1). Higher income quartiles had a higher proportion of Medicare and private payors, lower income quartiles had higher proportion of Medicaid. Higher income quartiles received a greater proportion of care in urban teaching hospitals, lower income quartiles received more care in rural hospitals.The prevalence of obesity, pulmonary disease, diabetes, and substance use decreased; prevalence of atrial fibrillation, valvular disease, and ischemic heart disease increased in higher income quartiles. Compared with lowest income, highest income residents had higher rates of pressor use (odds ratio [OR] 1.32, 95% CI 1.2 - 1.5, P < 0.001), mechanical circulatory support (OR 1.5, 95% CI 1.4 - 1.7, P < 0.001), cardiogenic shock (OR 1.18, 95% CI 1.11 - 1.25, P < 0.001), and cost ($16163 vs $12555). There was a decreasing, but statistically insignificant, difference in in-hospital mortality (OR 0.98, 95% CI 0.94 - 1.02, P = 0.35), and cardiac arrest (OR 0.95, 95% CI 0.9 - 1, P = 0.07); with no difference in disposition to care facility (OR 1.01, 95% CI 0.99 - 1.03, P = 0.216) in highest compared to lowest income quartiles.

Conclusions: We found differences in demographic and clinical outcomes across income quartiles, which could be suggestive of different factors contributing to HF development, its trajectory, and management based on SES.