Influence of Social Determinants of Health on Heart Failure Outcomes: A Systematic Review

Abstract

Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes. Selected articles were assessed for quality using a validated rating scheme. We identified 1373 unique articles for screening; 104 were selected for full‐text review, and 59 met the inclusion criteria, including retrospective and prospective cohort, cross‐sectional, and intervention studies. The majority examined readmissions and hospitalizations (k=33), mortality or survival (k=29), and success of medical devices and transplantation (k=8). SDoH examined most commonly included race, ethnicity, age, sex, socioeconomic status, and education or health literacy. Studies used a range of 1 to 9 SDoH as primary independent variables and 0 to 7 SDoH as controls. Multiple data sources were employed and frequently were electronic medical records linked with national surveys and disease registries. The effects of SDoH on HF outcomes were inconsistent because of the heterogeneity of data sources and SDoH constructs. Conclusions Our systematic review reveals shortcomings in measurement and deployment of SDoH variables in HF care. Validated measures need to be prospectively and intentionally collected to facilitate appropriate analysis, reporting, and replication of data across studies and inform the design of appropriate, evidence‐based interventions that can ameliorate significant HF morbidity and societal costs.

Educational status affects prognosis of patients with heart failure with reduced ejection fraction: A post‐hoc analysis from the WARCEF trial

“…Although some differences were observed between groups, the overall high use of such drugs represent a strength point of our analysis, and particularly on the association between educational level and risk of the primary outcome. Moreover, as reported by a recent comprehensive meta‐analysis, 20 the major issue arises in the lack of reporting SDOH variables, and a substantial knowledge gap exists in understanding how SDOH influence the outcomes of patients with HF, therefore it is important to reduce the knowledge gap with data coming from clinical trials.…”

Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review

“…This raises questions about the effectiveness of using these SDoH proxy variables, as their accuracy in representing true SDoH constructs remains uncertain. 79 Furthermore, even with the use of poor proxy variables, most of the studies lacked a comprehensive approach to measuring or controlling for all the 5 SDoH domains in their analyses. Only 30% of the included studies examined ≥4 SDoH domains as primary contributors or covariates to hypertension outcomes.…”

The Impact of Social Determinants of Health on Outcomes Among Individuals With HIV and Heart Failure: A Literature Review

“…Many health disparities stem from SDoH, which include the conditions of people's birth, development, living conditions, work environments, and aging processes [ 11 ]. SDoH have been identified as significant risk factors for adverse outcomes in patients with HIV and HF [ 9 , 10 ]. Recognizing and understanding the influence of SDoH on health outcomes across populations are crucial for diminishing health disparities.…”

“…It is recognized that SDoH (such as family support, housing conditions, financial status, education, and substance abuse) plays a pivotal role in patient outcomes [ 8 , 9 ]. This underscores the need for holistic healthcare strategies (e.g.…”