Social determinants are crucial factors in the long-term prognosis of severely decompensated acute heart failure in patients over 75 years of age

Background: The association between social factors and the long-term prognosis of acute heart failure (AHF) remains unclear.

Methods and results: One thousand fifty-one AHF patients were screened, and 915 were enrolled. Four hundred forty-two AHF patients ≥75 years of age (the elderly cohort) were also included in a sub-analysis. Participants who fulfilled one of the three marital status-, offspring-, and living status-related criteria were considered socially vulnerable. On this basis they were classified into the socially vulnerable (n=396) and non-socially vulnerable (n=519) groups in the overall cohort, and the socially vulnerable (n=219) and non-socially vulnerable (n=223) groups in the elderly cohort. Kaplan-Meier curves showed that the survival rate of the socially vulnerable group was significantly poorer than that of the non-socially vulnerable group in the overall (p=0.049) and elderly (p=0.004) cohorts. A multivariate Cox regression model revealed that social vulnerability was an independent predictor of 1000-day mortality in the overall [hazard ratio (HR): 1.340, 95% confidence interval (CI): 1.003-1.043, p=0.048] and elderly cohort (HR: 1.531, 95% CI: 1.027-2.280, p=0.036). Regarding the components of social vulnerability, the marital status was an independent factor in the elderly cohort (HR: 1.500, 95% CI 1.043-2.157, p=0.029).

Conclusion: Social vulnerability was independently associated with long-term outcomes in AHF patients, especially in the elderly cohort. Organization of the social structure of AHF patients might be able to improve their prognosis.