What do we know about socioeconomic status and congestive heart failure? A review of the literature

OBJECTIVE To examine and assess the available literature concerning the effects of socioeconomic status (SES) and congestive heart failure (CHT). STUDY DESIGN We examined electronic databases, including: MEDLINE, EMBASE, Social Science Citation Index, Science citation index, the Cochrane Database, and Bandolier. W( hand searched recent copies of appropriate journals and scrutinized lists of identified papers. The search terms we used included "heart failure," "cardiac failure," "ventricular dysfunction," "social class," "socioeconomic," "poverty," and "deprivation." Two reviewers independently examined and selected papers for inclusion. A standardized data collection form was used for data extraction. OUTCOMES MEASURED We measured (1) prevalence; (2) differences in care (eg, use of diagnostic tests); (3) morbidity (eg, health care use); and (4) mortality. DATA SOURCES We examined all English-language abstracts or papers concerning human research related to the subject of SES and CHF, including all clinical trials, reviews, discussion papers, and editorials. RESULTS Only 8 clinical studies were identified that specifically examined aspects of the relationship, between socioeconomic status and CHF. Key themes included increased hospitalization rates with increasing social deprivation; lower income inversely associated with being placed on a waiting list for transplantation; and that those of lower socioeconomic status had a greater severity of illness on admission. CONCLUSIONS There is a paucity of generalizable high-quality research in this subject area. Crucial issues not addressed include the effects, if any, of socioeconomic status on the behaviors of health care providers. Further investigation, with a more holistic approach, is necessary to inform future intervention strategies aimed at reducing excess mortality from CHF.