Abstract Body (Do not enter title and authors here): Background: Deprivation indices are composite scores that capture regional variation in social determinants of health (SDH) and have been independently linked to healthcare disparities. The social vulnerability index (SVI) is unique among these indices as it can be split into four unique themes for granular analysis. The purpose of this study is to assess whether SVI and SVI theme are independently associated with in-hospital outcomes and discharge prescription patterns of adults admitted to the hospital with heart failure with reduced ejection fraction (HFrEF).
Methods: This study included participants aged ≥18 years old hospitalized for HFrEF and eligible for guideline directed medical therapy (GDMT) in the Get With The Guidelines–Heart Failure (GWTG-HF) quality improvement (QI) program between June 5, 2013 and January 4, 2024. The primary outcomes were in-hospital mortality, GDMT at discharge, and length of stay. Hierarchical multivariable regression models with clustering by facility were used: (1) with SVI / SVI theme as the predictor, (2) partial adjustment for demographics, and (3) full adjustment for demographics and medical comorbidities.
Results: Among 186,928 patients with HFrEF without contraindication to any GDMT, 30,733 (16.4%) were from the lowest SVI quartile (least vulnerable) and 58,108 (31.1%) were from the highest SVI quartile (most vulnerable). Presented odds ratios (ORs) compare highest vs lowest SVI quartile. In-hospital mortality ORs decreased with increased SVI (unadjusted OR: 0.79, 95% CI 0.74-0.84), but were not statistically significant in fully adjusted models. GDMT rates at discharge were higher with higher SVI (unadjusted OR for ACE/ARB/ARNI: 1.14, 95% CI 1.11-1.18; for beta blocker: 1.12, 95% CI 1.05-1.19; for MRA: 1.12, 95% CI 1.09-1.16; for SGLT2i: 1.07, 95% CI 1.01-1.13), but were not statistically significant in fully adjusted models. Length of stay was significantly longer with higher SVI, including after adjustment (fully adjusted OR: 1.01, 95% CI 1.01-1.02). Replacing SVI with each SVI theme yielded similar results.
Conclusions: Among patients hospitalized for HFrEF at GWTG-HF hospitals, regional vulnerability defined by SVI was not associated with in-hospital mortality or GDMT at discharge after adjustment for individual demographics and medical comorbidities. Findings suggest that participation in QI programs such as GWTG-HF may help reduce the influence of regional SDH on care quality and in-hospital outcomes.