Key result
High neighborhood deprivation linked to ~39% higher 12-month CV readmission in HFrEF.
Why the study?
Few studies have examined how neighborhood-level factors affect outcomes for patients with heart failure with reduced ejection fraction.
Do adverse neighborhood factors like high deprivation and low walkability increase the risk of hospital readmission and mortality in patients with HFrEF?
Cohort (n=756)
Yes
Do adverse neighborhood factors like high deprivation and low walkability increase the risk of hospital readmission and mortality in patients with HFrEF?
Neighborhood disadvantage and low walkability are significant social determinants of health that independently predict increased risks of mortality and hospital readmission in patients with HFrEF.
Answers are grounded in this paper and cite their sources.
Neighborhood deprivation may raise HFrEF readmission risk; leaves open whether addressing social determinants improves outcomes.
BACKGROUND: Few studies have examined the impact of neighborhood-level factors on outcomes for patients with heart failure with reduced ejection fraction (HFrEF). OBJECTIVES: The purpose of this study was to understand the impact of neighborhood factors on readmission and mortality risk hospitalized patients with HFrEF. METHODS: We analyzed data from the Hopeful Heart Trial that evaluated the impact of blended collaborative care for treating HFrEF and depression among patients discharged from 8 Pittsburgh-area hospitals from March 2014 to October 2017. Using patients' home address at discharge to determine neighborhood Walk Score (WS; 0-100 scale) and Area Deprivation Index (ADI; 0-100), we examined the incidence of 12-month all-cause and cardiovascular-related hospital readmissions and vital status up to 5 years postdischarge through June 2022 using multivariable-adjusted Cox proportional hazards models. RESULTS: Hopeful Heart enrolled 756 people with HFrEF (baseline mean age 64.0, 44% female, 73% White race, 28% ± 9.1% mean left ventricular ejection fraction, mean 9-Item Patient Health Questionnaire score 12 ± 5.7, median WS 69 (IQR: 49-88), and median ADI 12 (IQR: 10-15) and followed them for a median of 57.7 months (IQR: 25.0-68.4). Individuals from the least walkable neighborhoods experienced greater 12-month all-cause mortality (HR: 1.70 [95% CI: 1.11-2.61]; P = 0.016), while those from the most deprived neighborhoods had higher 12-month cardiovascular-related hospital readmission (HR: 1.39 [95% CI: 1.09-1.78]; P = 0.008). Neither WS nor ADI predicted 12-month all-cause readmission and cardiovascular-related mortality or 5-year all-cause mortality. CONCLUSIONS: Among recently hospitalized HFrEF patients, neighborhood factors affect 12-month rehospitalization and mortality risk but not 5-year mortality. (Blended Collaborative Care for Heart Failure and Co-Morbid Depression; NCT02044211).
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Bober et al. (2025) conducted a cohort in Heart Failure with reduced ejection fraction (HFrEF) (n=756). Most deprived neighborhood (Area Deprivation Index Q4) vs. Less deprived neighborhood (Area Deprivation Index Q1-Q3) was evaluated on 12-month cardiovascular-related hospital readmission (HR 1.39, 95% CI 1.09-1.78, p=0.008). Living in the most deprived neighborhoods significantly increased the risk of 12-month cardiovascular-related hospital readmission (HR 1.39) compared to less deprived neighborhoods in patients with HFrEF.
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