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Verma, Amanda K., MD; Schulte, Phillip J., PhD; Bittner, Vera, MD, MSPH; Keteyian, Steven J., PhD; Fleg, Jerome L., MD; Piña, Ileana L., MD, MPH; Swank, Ann M., PhD; Fitz-Gerald, Meredith, RN, BSN; Ellis, Stephen J., PhD; Kraus, William E., MD; Whellan, David J., MD, MHS; O'Connor, Christopher M., MD; Mentz, Robert J., MD
The American heart journal, 01/2017, Volume: 183Journal Article
Abstract Background Prognosis in heart failure (HF) patients 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 2331 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 HR 0.91, 95% Confidence Interval CI: 0.81–1.03, P = .15) and more than a high school education (HR 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 > .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 chronic HF patients. These findings provide information that may be considered as potential variables impacting outcomes.
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