Socioeconomic and partner status in chronic heart failure: Relationship to exercise capacity, quality of life, and clinical outcomes

Amanda K. Verma, Phillip J. Schulte, Vera Bittner, Steven J. Keteyian, Jerome L. Fleg, Ileana L. Pina, Ann M. Swank, Meredith Fitz-Gerald, Stephen J. Ellis, William E. Kraus, David J. Whellan, Christopher M. O'Connor, Robert J. Mentz

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Prognosis in patients with heart failure (HF) is commonly assessed based on clinical characteristics. The association between partner status and socioeconomic status (SES) and outcomes in chronic HF requires further study. Methods We performed a post hoc analysis of HF-ACTION, which randomized 2,331 HF patients with ejection fraction ≤35% to usual care ± aerobic exercise training. We examined baseline quality of life and functional capacity and outcomes (all-cause mortality/hospitalization) by partner status and SES using adjusted Cox models and explored an interaction with exercise training. Outcomes were examined based on partner status, education level, annual income, and employment. Results Having a partner, education beyond high school, an income >$25,000, and being employed were associated with better baseline functional capacity and quality of life. Over a median follow-up of 2.5 years, higher education, higher income, being employed, and having a partner were associated with lower all-cause mortality/hospitalization. After multivariable adjustment, lower mortality was seen associated with having a partner (hazard ratio 0.91, 95% CI 0.81-1.03, P =.15) and more than a high school education (hazard ratio 0.91, CI 0.80-1.02, P =.12), although these associations were not statistically significant. There was no interaction between any of these variables and exercise training on outcomes (all P > 0.5). Conclusions Having a partner and higher SES were associated with greater functional capacity and quality of life at baseline but were not independent predictors of long-term clinical outcomes in patients with chronic HF. These findings provide information that may be considered as potential variables impacting outcomes.

Original languageEnglish (US)
Pages (from-to)54-61
Number of pages8
JournalAmerican Heart Journal
Volume183
DOIs
StatePublished - Jan 1 2017

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Social Class
Heart Failure
Quality of Life
Exercise
Education
Mortality
Hospitalization
Proportional Hazards Models

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Socioeconomic and partner status in chronic heart failure : Relationship to exercise capacity, quality of life, and clinical outcomes. / Verma, Amanda K.; Schulte, Phillip J.; Bittner, Vera; Keteyian, Steven J.; Fleg, Jerome L.; Pina, Ileana L.; Swank, Ann M.; Fitz-Gerald, Meredith; Ellis, Stephen J.; Kraus, William E.; Whellan, David J.; O'Connor, Christopher M.; Mentz, Robert J.

In: American Heart Journal, Vol. 183, 01.01.2017, p. 54-61.

Research output: Contribution to journalArticle

Verma, AK, Schulte, PJ, Bittner, V, Keteyian, SJ, Fleg, JL, Pina, IL, Swank, AM, Fitz-Gerald, M, Ellis, SJ, Kraus, WE, Whellan, DJ, O'Connor, CM & Mentz, RJ 2017, 'Socioeconomic and partner status in chronic heart failure: Relationship to exercise capacity, quality of life, and clinical outcomes', American Heart Journal, vol. 183, pp. 54-61. https://doi.org/10.1016/j.ahj.2016.10.007
Verma, Amanda K. ; Schulte, Phillip J. ; Bittner, Vera ; Keteyian, Steven J. ; Fleg, Jerome L. ; Pina, Ileana L. ; Swank, Ann M. ; Fitz-Gerald, Meredith ; Ellis, Stephen J. ; Kraus, William E. ; Whellan, David J. ; O'Connor, Christopher M. ; Mentz, Robert J. / Socioeconomic and partner status in chronic heart failure : Relationship to exercise capacity, quality of life, and clinical outcomes. In: American Heart Journal. 2017 ; Vol. 183. pp. 54-61.
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abstract = "Background Prognosis in patients with heart failure (HF) is commonly assessed based on clinical characteristics. The association between partner status and socioeconomic status (SES) and outcomes in chronic HF requires further study. Methods We performed a post hoc analysis of HF-ACTION, which randomized 2,331 HF patients with ejection fraction ≤35{\%} to usual care ± aerobic exercise training. We examined baseline quality of life and functional capacity and outcomes (all-cause mortality/hospitalization) by partner status and SES using adjusted Cox models and explored an interaction with exercise training. Outcomes were examined based on partner status, education level, annual income, and employment. Results Having a partner, education beyond high school, an income >$25,000, and being employed were associated with better baseline functional capacity and quality of life. Over a median follow-up of 2.5 years, higher education, higher income, being employed, and having a partner were associated with lower all-cause mortality/hospitalization. After multivariable adjustment, lower mortality was seen associated with having a partner (hazard ratio 0.91, 95{\%} CI 0.81-1.03, P =.15) and more than a high school education (hazard ratio 0.91, CI 0.80-1.02, P =.12), although these associations were not statistically significant. There was no interaction between any of these variables and exercise training on outcomes (all P > 0.5). Conclusions Having a partner and higher SES were associated with greater functional capacity and quality of life at baseline but were not independent predictors of long-term clinical outcomes in patients with chronic HF. These findings provide information that may be considered as potential variables impacting outcomes.",
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T2 - Relationship to exercise capacity, quality of life, and clinical outcomes

AU - Verma, Amanda K.

AU - Schulte, Phillip J.

AU - Bittner, Vera

AU - Keteyian, Steven J.

AU - Fleg, Jerome L.

AU - Pina, Ileana L.

AU - Swank, Ann M.

AU - Fitz-Gerald, Meredith

AU - Ellis, Stephen J.

AU - Kraus, William E.

AU - Whellan, David J.

AU - O'Connor, Christopher M.

AU - Mentz, Robert J.

PY - 2017/1/1

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N2 - Background Prognosis in patients with heart failure (HF) is commonly assessed based on clinical characteristics. The association between partner status and socioeconomic status (SES) and outcomes in chronic HF requires further study. Methods We performed a post hoc analysis of HF-ACTION, which randomized 2,331 HF patients with ejection fraction ≤35% to usual care ± aerobic exercise training. We examined baseline quality of life and functional capacity and outcomes (all-cause mortality/hospitalization) by partner status and SES using adjusted Cox models and explored an interaction with exercise training. Outcomes were examined based on partner status, education level, annual income, and employment. Results Having a partner, education beyond high school, an income >$25,000, and being employed were associated with better baseline functional capacity and quality of life. Over a median follow-up of 2.5 years, higher education, higher income, being employed, and having a partner were associated with lower all-cause mortality/hospitalization. After multivariable adjustment, lower mortality was seen associated with having a partner (hazard ratio 0.91, 95% CI 0.81-1.03, P =.15) and more than a high school education (hazard ratio 0.91, CI 0.80-1.02, P =.12), although these associations were not statistically significant. There was no interaction between any of these variables and exercise training on outcomes (all P > 0.5). Conclusions Having a partner and higher SES were associated with greater functional capacity and quality of life at baseline but were not independent predictors of long-term clinical outcomes in patients with chronic HF. These findings provide information that may be considered as potential variables impacting outcomes.

AB - Background Prognosis in patients with heart failure (HF) is commonly assessed based on clinical characteristics. The association between partner status and socioeconomic status (SES) and outcomes in chronic HF requires further study. Methods We performed a post hoc analysis of HF-ACTION, which randomized 2,331 HF patients with ejection fraction ≤35% to usual care ± aerobic exercise training. We examined baseline quality of life and functional capacity and outcomes (all-cause mortality/hospitalization) by partner status and SES using adjusted Cox models and explored an interaction with exercise training. Outcomes were examined based on partner status, education level, annual income, and employment. Results Having a partner, education beyond high school, an income >$25,000, and being employed were associated with better baseline functional capacity and quality of life. Over a median follow-up of 2.5 years, higher education, higher income, being employed, and having a partner were associated with lower all-cause mortality/hospitalization. After multivariable adjustment, lower mortality was seen associated with having a partner (hazard ratio 0.91, 95% CI 0.81-1.03, P =.15) and more than a high school education (hazard ratio 0.91, CI 0.80-1.02, P =.12), although these associations were not statistically significant. There was no interaction between any of these variables and exercise training on outcomes (all P > 0.5). Conclusions Having a partner and higher SES were associated with greater functional capacity and quality of life at baseline but were not independent predictors of long-term clinical outcomes in patients with chronic HF. These findings provide information that may be considered as potential variables impacting outcomes.

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