Impact of public assistance on long-term outcomes after hospitalization for acute heart failure

Background Socioeconomic disparities adversely affect heart failure (HF) outcomes; however, the extent to which public assistance (PA) mitigates these differences remains uncertain. Methods and results We retrospectively analyzed 596 patients who were discharged alive after hospitalization for acute HF between January and December 2015. The patients were classified according to their PA status. The primary outcome was a composite of all-cause death and HF rehospitalization. Secondary outcomes included individual components. Kaplan–Meier curves were used to compare unadjusted event rates, while Cox proportional hazards models adjusted for 25 clinical and sociodemographic covariates were used to evaluate associations in the full cohort. To confirm model robustness, 1:1 propensity score matching (PSM) was performed ( n = 82 pairs) and sensitivity analyses were conducted in the matched cohort. The mean medical follow-up duration was 3.5 years. In the entire cohort, the primary outcome occurred in 69.6% of patients. During follow-up, the cumulative incidence of the primary outcome did not differ significantly between the PA and non-PA groups (log-rank test, p = 0.45). In the multivariable analysis, PA was not associated with a higher risk of the primary outcome (hazard ratio HR, 1.06; 95% confidence interval CI, 0.78–1.40; p = 0.68). Similar results were observed after PSM (HR, 0.87; 95% CI, 0.61–1.24; p = 0.46). Conclusion PA was not associated with worse long-term outcomes after hospitalization for acute HF, suggesting that comprehensive public insurance coverage may help reduce socioeconomic disparities in HF care.