PMID- 32767628
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 7
IP  - 5
DP  - 2020 Oct
TI  - Inequalities in heart failure care in a tax-financed universal healthcare system: 
      a nationwide population-based cohort study.
PG  - 3095-3108
LID - 10.1002/ehf2.12938 [doi]
AB  - AIMS: Data on socioeconomic-related differences in heart failure (HF) care are 
      sparse. Inequality in care may potentially contribute to a poor clinical outcome. 
      We examined socioeconomic-related differences in quality of HF care among 
      patients with incident HF with reduced ejection fraction (EF) (HFrEF). METHODS 
      AND RESULTS: We conducted a nationwide population-based cohort study among 
      patients with HFrEF (EF </=40%) registered from January 2008 to October 2015 in the 
      Danish Heart Failure Registry, a nationwide registry of patients with a 
      first-time primary HF diagnosis. Associations between individual-level 
      socioeconomic factors (cohabitation status, education, and family income) and the 
      quality of HF care defined by six guideline-recommended process performance 
      measures [New York Heart Association (NYHA) classification, treatment with 
      angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin receptor blockers 
      (ARB), beta-blockers and mineralocorticoid receptor antagonists, exercise 
      training, and patient education] were assessed using multiple imputation and 
      multivariable logistic regression controlling for potential confounders. Among 17 
      122 HFrEF patients included, 15 290 patients had data on all six process 
      performance measures. Living alone was associated with lower odds of NYHA 
      classification [adjusted OR (aOR) 0.81; 95% confidence interval (CI): 0.72-0.90], 
      prescription of ACEI/ARB (aOR 0.76; 95% CI: 0.68-0.88) and beta-blockers (aOR 
      0.84; 95% CI: 0.76-0.93), referral to exercise training (aOR 0.75; 95% CI: 
      0.69-0.81), and patient education (aOR 0.73; 95% CI: 0.67-0.80). Compared with 
      high-level education, low-level education was associated with lower odds of NYHA 
      classification (aOR 0.93; 95% CI: 0.79-1.11), treatment with ACEI/ARB (aOR 0.99; 
      95% CI: 0.81-1.20) and beta-blockers (aOR 0.93; 95% CI: 0.79-1.09), referral to 
      exercise training (aOR 0.73; 95% CI: 0.65-0.82), and patient education (aOR 0.86, 
      95% CI: 0.75-0.98). An income in the lowest tertile was associated with lower 
      odds of NYHA classification (aOR 0.67; 95% CI: 0.58-0.79), prescription of 
      ACEI/ARB (aOR 0.80, 95% CI: 0.67-0.95) and beta-blockers (aOR 0.88, 95% CI: 
      0.86-1.01), referral to exercise training (aOR 0.59, 95% CI: 0.53-0.64), and 
      patient education (aOR 0.66; 95% CI: 0.59-0.74) compared with an income in the 
      highest tertile. Overall, no systematic differences were seen when the analyses 
      were stratified by sex and age groups. CONCLUSIONS: Living alone, low-level 
      education, and income in the lowest tertile were associated with reduced use of 
      recommended processes of HF care among Danish HFrEF patients with a first-time 
      primary HF diagnosis. Efforts are warranted to ensure guideline-recommended HF 
      care to all HFrEF patients, irrespective of socioeconomic background.
CI  - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of the European Society of Cardiology.
FAU - Schjodt, Inge
AU  - Schjodt I
AUID- ORCID: 0000-0003-4086-2281
AD  - Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens 
      Boulevard 99, Aarhus, 8200, Denmark.
FAU - Johnsen, Soren P
AU  - Johnsen SP
AD  - Danish Center for Clinical Health Services Research, Department of Clinical 
      Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark.
FAU - Stromberg, Anna
AU  - Stromberg A
AD  - Department of Health, Medicine and Caring Sciences and Department of Cardiology, 
      Linkoping University, Linkoping, Sweden.
FAU - Valentin, Jan B
AU  - Valentin JB
AD  - Danish Center for Clinical Health Services Research, Department of Clinical 
      Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark.
FAU - Logstrup, Brian B
AU  - Logstrup BB
AD  - Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens 
      Boulevard 99, Aarhus, 8200, Denmark.
AD  - Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
LA  - eng
GR  - 17-B-0104/Helsefonden/International
GR  - 17-B-0104/the Danish Nurses' Organization Research Foundation/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200807
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
SB  - IM
MH  - Angiotensin Receptor Antagonists
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Cohort Studies
MH  - *Heart Failure/epidemiology/therapy
MH  - Humans
MH  - Stroke Volume
MH  - Universal Health Care
PMC - PMC7524228
OTO - NOTNLM
OT  - Heart failure with reduced ejection fraction
OT  - Inequalities
OT  - Performance measures| registry
OT  - Social class
OT  - Socioeconomic factors| HFrEF
COIS- None declared.
EDAT- 2020/08/09 06:00
MHDA- 2021/06/22 06:00
PMCR- 2020/08/07
CRDT- 2020/08/09 06:00
PHST- 2020/05/04 00:00 [received]
PHST- 2020/06/30 00:00 [revised]
PHST- 2020/07/16 00:00 [accepted]
PHST- 2020/08/09 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/08/09 06:00 [entrez]
PHST- 2020/08/07 00:00 [pmc-release]
AID - EHF212938 [pii]
AID - 10.1002/ehf2.12938 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2020 Oct;7(5):3095-3108. doi: 10.1002/ehf2.12938. Epub 2020 Aug 
      7.