Senior Specialist, Real World Evidence OM1 Inc., United States
Background: Cardiovascular disease remains the leading cause of death globally, and nearly one million patients are newly diagnosed with heart failure (HF) in the United States each year. There is increased interest in the role social determinants of health (SDoH) have in morbidity and mortality from chronic conditions such as HF.
Objectives: To describe the social and medical characteristics of patients diagnosed with HF in a U.S. real-world cohort and to identify characteristics associated with 1-year survival.
Methods: Data were derived from the PremiOM™ Heart Failure Dataset (OM1, Boston, MA), a multi-source real-world dataset with linked healthcare claims, social determinants of health, and electronic medical records data on U.S. patients with HF from all 50 states, beginning in 2013. Patients were included if they were alive, with all data elements available, at the beginning of the study period (6/30/2021 - 6/30/2022).
Patient characteristics by sex were described at baseline, which include age, race, New York Heart Association (NYHA) classification for HF severity, Charlson comorbidity index (CCI), and OM1 Medical Burden Index (OMBI). The OMBI is a standardized measure of combined medical burden, on 0-1000 scale, generated from extensive analysis of OM1’s longitudinal patient cohort. Measures of SDoH included home ownership status, highest education level, and household income.
Logistic regression was used to quantify the association between patient and disease characteristics and 1-year survival.
Results: This analysis included 11,010 adult patients with HF (4,840 women [mean age 74.6 years, SD 10.4] and 6,170 men [mean age 73.7 years, SD 10.0]). On average, women had a slightly lower medical burden than men (OMBI mean [SD]: 644.9 [243.8] vs 653.4 [243.0]; CCI mean [SD]: 3.5 [2.4] vs 3.7 [2.5]).
After one year, 3.3% of patients had died of any cause. Key characteristics associated with lower odds of survival at one year were age (per 5 years; adjusted odds ratio [95% confidence interval (CI)]: 0.7 [0.7, 0.8]), higher NYHA class (0.7 [0.6, 0.8]), OMBI (per 100 points; 0.9 [0.8, 0.9]), higher CCI (0.9 [0.8, 0.9]) In contrast, patients with higher annual income (per $10,000; 1.1 [1.0, 1.1]), who were female (1.5 [1.2, 1.8]), and who owned a home (1.5 [1.1, 2.1]) were more likely to be alive at one year.
Conclusions: In a real-world cohort of patients with HF, SDoH including higher household income and home ownership were independently associated with increased odds of all-cause 1-year survival. Further research is needed to understand the ways in which SDoH may impact morbidity and mortality for patients with HF.
