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Income level and survival of heart failure patients: lessons from the Danish HF experience

Comment by Najat Mouine, EAPC Young Community

Risk Factors and Prevention

Heart failure (HF) is among the leading healthcare problems across the globe due to its massive contribution to morbidity and mortality profile over the last few decades.

This comment analyses the studies from Andersen et al. which examined the effects of socioeconomic status on the survival of patients with HF treated in a national healthcare system from Denmark. (1,2)

This national register-based cohort study describes the distribution of socio demographic factors such as age, income, type of living, educational level, retirement status, ownership of home, as well as clinical characteristics such as comorbidities and prior medical treatment according to socio economic status stratified by sex.

The authors examined whether initiation of and adherence to b-blocker and Renin Angiotensin System inhibitor treatment and use of device therapy differ according to socioeconomic position in patients with HF.
The age group was 40–80 years. They identified three indicators of treatment as mediators of the income mortality association which were initiation of medical treatment, breaks in medical treatment, and use of device therapy. The primary outcome was all-cause mortality evaluated 1 year after the index date
The authors conclude that mortality outcomes related to HF are poor in low socio-economic strata and a portion of that could be attributed to delay in initiation of medical treatment.

They give us conclusive results in the association of income level and type of living with early initiation of medical treatment, medication adherence and use of device therapy for HF patients which ultimately affects the survival of the patients.

The authors suggested that these results need to be confirmed by future well-structured prospective studies.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


Najat Mouine commented on those articles:

  1. Andersen J, Gerds TA, Hlatky MA, Gislason G, Schou M, Torp-Pedersen C, Møller S, Madelaire C, Strandberg-Larsen K. The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study. Eur J Prev Cardiol 2020; doi: 10.1093/eurjpc/zwaa005.
  2. Andersen J, Gerds TA, Gislason G, Schou M, Torp-Pedersen C, Hlatky MA, Møller S, Madelaire C, Strandberg-Larsen K. Socioeconomic position and one-year mortality risk among patients with heart failure: a nationwide register-based cohort study. Eur J Prev Cardiol 2020;27:79–88