Abstract 11595: The Influence of Social Determinants on Heart Failure Outcomes: A Systematic Review

Abstract

Introduction: Heart failure (HF) is an ongoing health concern that is expected to affect 9 million Americans by 2030. Growing research shows the association between non-clinical, social determinants of health (SDoH) and adverse outcomes (hospitalizations, high costs, and premature mortality). Providers must be able to identify SDoH risk factors to improve care delivery and patient outcomes. Aim: To summarize how SDoH risk factors have been included, defined, measured, and assessed in studies that examine outcomes in the HF care continuum. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a search of five databases was conducted for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH risk factors on outcomes among subjects with HF. Study quality was assessed using NIH’s quality assessment tools. Results: The search identified 1,209 unique records; 108 were selected for full-text review. In total, 59 articles including retrospective and prospective cohort, cross-sectional, and intervention studies met criteria for inclusion. The majority of studies examined readmissions and hospitalizations (k=36); mortality or survival (k=32); and success of medical devices and transplantation (k=8). SDoH risk factors most commonly evaluated were race/ethnicity; age; gender; SES; social support; and education or health literacy. Studies used a range of 1-9 SDoH (M = 3.6, SD = 2.2) as primary independent variables and 0-7 SDoH as controls (M = 2.4, SD = 2.1). The studies used multiple data sources, frequently EMR linked with national surveys, disease registries, and/or data from large national studies. Overall, the effects of the SDoH risk factors on HF outcomes were mixed, and these differences appeared to be related to heterogeneity of data sources and SDoH constructs employed across studies. Conclusions: Our systematic review suggests that the influence of SDoH on HF outcomes remains incompletely assessed in part due to both inconsistent measurement and absence of potentially relevant variables. More expansive, real-time SDoH data collection is required if HF interventions are to meaningfully impact value-based and patient-centered models of care.