Heart failure patients face more readmissions if they live in poor neighborhoods

Potential quandary for safety-net hospitals
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Patients admitted to a hospital for heart failure are significantly more likely to be readmitted within six months of discharge if they reside in a neighborhood with a low socioeconomic status, according to a study in the most recent issue of the journal Circulation.

Researchers found patients living in neighborhoods with a low socioeconomic level were approximately 17 percent more likely to return to a hospital within six months of discharge than patients who live in wealthier neighborhoods, after adjustments for a variety of other conditions.

"Previous research has shown that neighborhood socioeconomic status is associated with the incidence and outcomes of other cardiovascular diseases, as well as all-cause mortality, even after adjustment for individual-level risk factors," the study's authors wrote. They added that their data was supported by other research indicating that even a temporary move to a better neighborhood tended to improve physical and mental health.

"The availability of healthcare resources, nutritious food options and outlets for physical activity in a neighborhood may influence cardiovascular risk factors and self-management of chronic disease. Community-level stressors (e.g., pollution and crime) and social norms may also play a role in worsening of heart failure," the authors wrote. "Neighborhoods may also be associated with the quality of care."

Despite the greater likelihood that residents of poorer neighborhoods were at risk for readmission, the mortality rates among the patient cohorts studied remained about the same.

The conclusion of the study could prove troubling for safety-net hospitals, which tend to serve poorer and uninsured populations and, like virtually all inpatient providers, are under pressure to improve patient care outcomes, particularly for those with chronic conditions, such as congestive heart failure.

Another study recently concluded that safety-net hospitals were more likely to receive financial penalties from the Medicare program for readmissions than other types of facilities. And safety-net providers in states that have not expanded Medicaid eligibility under the Affordable Care Act are particularly vulnerable to cuts in the disproportionate share hospital program.

To learn more:
- check out the study (.pdf)

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