Social Risk and Mortality

Background Heart failure (HF) is a chronic condition that usually leads to death a few years after diagnosis. Although several clinical factors have been found to be related to increased mortality, less is known about the impact of social context, especially at the end stage of the disease. Knowing about social context is important to properly classify risk and provide holistic management for patients with advanced HF. Objective The aim of this study was to determine the impact of social context on mortality in patients with advanced HF. Methods A retrospective cohort study was conducted using data from clinical records on community-dwelling patients with HF and with New York Heart Association IV functional class living in Catalonia in northeastern Spain. Clinical data, patient dependency for basic activities of daily living, and social assessments were collected between 2010 and 2013. The primary outcome was all-cause mortality. Results Data from 1148 New York Heart Association class IV patients were analyzed. Mean (SD) age was 82 (9.0) years, and 61.7% were women. The mean (SD) follow-up was 18.2 (11.9) months. Mortality occurred in 592 patients. Social risk was identified in 63.6% of the patients, and 9.3% acknowledged having social problems. In the adjusted multivariate model, being male (hazard ratio (HR), 1.82; 95% confidence interval [CI], 1.16–2.83), having high dependency on others for basic activities of daily living (HR, 2.16; 95% CI, 1.21–3.85), and presenting with a social problem (HR, 2.46; 95% CI, 1.22–4.97) were related to an increased risk of mortality. Conclusions An unfavorable social profile is an independent risk factor for mortality in patients with advanced HF.