Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association

Abstract

Heart failure is a clinical syndrome that affects >6.5 million Americans, with an estimated 550 000 new cases diagnosed each year. The complexity of heart failure management is compounded by the number of patients who experience adverse downstream effects of the social determinants of health (SDOH). These patients are less able to access care and more likely to experience poor heart failure outcomes over time. Many patients face additional challenges associated with the cost of complex, chronic illness management and must make difficult decisions about their own health, particularly when the costs of medications and healthcare appointments are at odds with basic food and housing needs. This scientific statement summarizes the SDOH and the current state of knowledge important to understanding their impact on patients with heart failure. Specifically, this document includes a definition of SDOH, provider competencies, and SDOH assessment tools and addresses the following questions: (1) What models or frameworks guide healthcare providers to address SDOH? (2) What are the SDOH affecting the delivery of care and the interventions addressing them that affect the care and outcomes of patients with heart failure? (3) What are the opportunities for healthcare providers to address the SDOH affecting the care of patients with heart failure? We also include a case study ( Data Supplement ) that highlights an interprofessional team effort to address and mitigate the effects of SDOH in an underserved patient with heart failure.

The Importance of Gender to Understand Sex Differences in Cardiovascular Disease

“…Dans cet article de synthèse, nous explorons la litt erature actuelle qui se penche sur la part du genre dans le risque de maladie CV et sur son effet sur les facteurs de risque etablis, etape essentielle vers une m edecine de pr ecision. important impact on overall disease outcomes 41,42 (Table 1). Marital stress has been shown to increase the risk of recurrent cardiac events in women with established IHD.…”

The year in cardiovascular medicine 2020: heart failure and cardiomyopathies

“…3 Zapravo, životni stil i socijalne odrednice zdravlja privlače sve više pažnju u epidemiologiji i skrbi bolesnika s HF-om. 4 U bolesnika s novootkrivenom HFom najčešći prvi sljedeći događaji jesu srčani incident (36 %), ponavljajuća HF (28 %) ili smrt (29 %). 5 Netradicionalni čimbenik rizika, kao što je to implantacija elektrostimulatora srca, može imati ulogu u razvoju HF-a: unutar prvih dviju godina nakon implantacije u bolesnika bez poznatog HF-a, učestalost je fatalnog i nefatalnog HF-a 10,6 %, šest puta veća nego u za po dobi i spolu sparenih osoba bez HF-a i elektrostimulatora srca.…”

“…3 Actually, lifestyle and social determinants of health are attracting more attention in the epidemiology and care of patients with HF. 4 In patients with new-onset HF, the most common first events are cardiac events (36%), recurrent HF (28%), and death (29%). 5 Non-traditional risk factors, such as pacemaker implantation may play a role in the development of HF: within the first 2 years after implantation in patients without known HF, the incidence of fatal and non-fatal HF is 10.6%, six times higher than for age-and gender-matched individuals without HF and pacemaker.…”

The year in cardiovascular medicine 2020: heart failure and cardiomyopathies

“…3 Actually, lifestyle and social determinants of health are attracting more attention in the epidemiology and care of patients with HF. 4 In patients with new-onset HF, the most common first events are cardiac events (36%), recurrent HF (28%), and death (29%). 5…”