Socioeconomic deprivation is associated with a lower likelihood of referral for advanced heart failure (HF) evaluation, but it is not known whether it influences rates of advanced HF therapies independently of key hemodynamic measures and comorbidity following advanced HF evaluation in a universal healthcare system. We linked data from a single-center Danish clinical registry of consecutive patients evaluated for advanced HF with patient-level information on socioeconomic status. Patients were divided into groups based on the level of education (low, medium, and high), combined degree of socioeconomic deprivation (low, medium, and high), and household income quartiles. Rates of the combined outcome of left ventricular assist device implantation or heart transplantation (advanced HF therapy) with death as a competing risk were estimated with cumulative incidence functions, and Cox proportional hazards models adjusted for age, sex, central venous pressure, cardiac index, and comorbidities. We included 629 patients, median age 53 years, of whom 77% were men. During a median follow-up of 5 years, 179 (28%) underwent advanced HF therapy. The highest level of education was associated with higher rates (high vs. low, adjusted HR 1.81 95% CI 1.14-2.89, p = 0.01), whereas household income quartile groups (Q4 vs. Q1, adjusted HR 1.37 95% CI 0.76-2.47, p=0.30) or groups of combined socioeconomic deprivation (high vs. low degree of deprivation, adjusted HR 0.86 95% CI 0.50-1.46, p = 0.56) were not significantly associated with rates of advanced HF therapy. Patients with a lower level of education might be disfavored for advanced HF therapies and could require specific attention in the advanced HF care center.

中文翻译：

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社会经济状况对晚期心力衰竭治疗率的影响

社会经济剥夺与转诊进行高级心力衰竭 (HF) 评估的可能性较低有关，但尚不清楚它是否会影响高级心力衰竭治疗的比率，而与全民医疗保健系统中高级心力衰竭评估后的关键血流动力学指标和合并症无关。我们将丹麦单中心临床登记处连续评估晚期心力衰竭患者的数据与患者的社会经济状况信息联系起来。根据教育水平（低、中和高）、社会经济剥夺综合程度（低、中和高）和家庭收入四分位数将患者分为几组。左心室辅助装置植入或心脏移植（高级心力衰竭治疗）与死亡作为竞争风险的综合结果率通过累积发生率函数和根据年龄、性别、中心静脉压、心脏指数、和合并症。我们纳入了 629 名患者，中位年龄 53 岁，其中 77% 是男性。在中位随访 5 年期间，179 名患者 (28%) 接受了高级心力衰竭治疗。最高教育水平与较高的比率相关（高与低，调整后 HR 1.81 95% CI 1.14-2.89，p = 0.01），而家庭收入四分位数组（Q4 与 Q1，调整后 HR 1.37 95% CI 0.76- 2.47，p = 0.30）或综合社会经济剥夺组（高剥夺程度与低剥夺程度，调整后 HR 0.86 95% CI 0.50-1.46，p = 0.56）与高级心力衰竭治疗率没有显着相关。教育水平较低的患者可能不适合高级心力衰竭治疗，并且可能需要高级心力衰竭护理中心的特别关注。