Poor patients with heart failure at higher risk of readmission

In residential neighbourhoods, patients with heart failure (HF) living in high poverty are more likely to be readmitted to hospitals, a recent study has found. The high rates of hypertension and diabetes in these areas partly explain the effect of high poverty.

This study explored how some facets of residential neighbourhood conditions (ie, observed built environment, census-based area-level poverty, and perceived disorder) influenced readmission in urban patients with HF. A team of researchers enrolled 400 HF patients who were discharged alive from an urban university teaching hospital. They collected data about readmissions during a 2-year follow-up.

The impact of residential neighbourhood conditions on hospital readmissions was assessed, adjusting for the following blocks of covariates: patient demographic characteristics, comorbidities, clinical characteristics, depression, perceived stress, health behaviours, and hospitalization characteristics.

Of the participants, 83.3 percent were readmitted. Those from high-poverty census tracts (≥20 percent) had a higher risk of readmission than patients from census tracts with <10-percent poverty (hazard ratio [HR], 1.53, 95 percent confidence interval [CI], 1.03‒2.27; p<0.05) when adjusted for demographics.

Of note, none of the built environmental or perceived neighbourhood conditions showed a significant relationship with the risk of readmission. In addition, the poverty-related readmission risk weakened after including diabetes (HR, 1.33) and hypertension (HR, 1.35) in the models.

“Improving diabetes and blood pressure control or structural aspects of impoverished areas may help reduce hospital readmissions,” the researchers said.