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Socioeconomic status and prognosis of heart failure with reduced vs. preserved ejection fraction: A propensity-matched study in the community.
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  • Jose L Puerto,
  • Rocio Gomez,
  • Jose L. Andrey,
  • Sotero P Romero,
  • Maria J. Pedrosa,
  • Manuel Rosety-Rodriguez,
  • Francisco Gomez
Jose L Puerto
Hospital Universitario Puerto Real. University of Cadiz, School of Medicine.
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Rocio Gomez
Hospital Universitario Puerto Real. University of Cadiz, School of Medicine
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Jose L. Andrey
Hospital Universitario Puerto Real. University of Cadiz, School of Medicine
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Sotero P Romero
Hospital Universitario Puerto Real. University of Cadiz, School of Medicine
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Maria J. Pedrosa
Hospital Universitario Puerto Real. University of Cadiz, School of Medicine
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Manuel Rosety-Rodriguez
Unversity of Cadiz, School of Medicine
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Francisco Gomez
Hospital Universitario Puerto Real. University of Cadiz, School of Medicine
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Abstract

Background: The relationship between socioeconomic status (SES) and the prognosis of HF with reduced (HFrEF) vs. preserved (HFpEF) ejection fraction remains unsettled. Objective: To analyze the relationship between SES and the prognosis of patients with incident HFrEF and HFpEF. Methods: Prospective study over 15 years (2003-2017) on 9658 patients diagnosed with HF. Main outcomes were mortality and hospitalizations for HF. The independent relationship between SES and the prognosis, stratifying patients for cardiovascular co-morbidity after propensity score-matching was analyzed. Results: After matching 7116 patients, during a median follow-up of 8.11 years, 5616 patients died (78.9%) and 5549 patients were hospitalized (78.0%). High income level was associated with a lower all-cause mortality (RR for HF patients [95% CI]: 0.86 [0.80-0.92], RR for HFrEF: 0.88 [0.82-0.95] and RR for HFpEF: 0.82 [0.75-0.90], P <0.001 in all cases), and cardiovascular mortality (RR for HF: 0.84 [0.76-0.92], RR for HFrEF: 0.87 [0.81-0.93] and RR for HFpEF: 0.88 [0.77-0.88], P <0.001 in all cases), less hospitalizations (RR for HF: 0.70 [0.65-0.78], RR for HFrEF: 0.78 [0.68-0.88] and RR for HFpEF: 0.61 [0.55-0.68], P <0.001 in all cases), and less 30-day readmissions (RR for HF: 0.67 [0.59-0.75], RR for HFrEF: 0.71 [0.63-0.79] and RR for HFpEF: 0.61 [0.55-0.69], P <0.001 in all cases), after adjustment for comorbidities, and other potential confounders. Analyses of recurrent hospitalizations gave larger SES benefits than time-to-first-event analyses. Conclusions: In this propensity-matched study, a high net annual household income is associated with an improved prognosis of patients with incident HFrEF and HFpEF.

Peer review status:ACCEPTED

11 Jun 2020Submitted to International Journal of Clinical Practice
19 Jun 2020Submission Checks Completed
19 Jun 2020Assigned to Editor
19 Jun 2020Reviewer(s) Assigned
20 Jul 2020Review(s) Completed, Editorial Evaluation Pending
06 Aug 20201st Revision Received
06 Aug 2020Submission Checks Completed
06 Aug 2020Assigned to Editor
06 Aug 2020Reviewer(s) Assigned
16 Aug 2020Review(s) Completed, Editorial Evaluation Pending
16 Aug 2020Editorial Decision: Accept