Exploring the Evolution of Heart Failure Symptoms After Hospitalization and Associations With Social Determinants of Health and Demographic Characteristics

BACKGROUND: There is little data on how heart failure (HF) symptoms change after hospitalization for HF (HFH) or with social determinants of health (SDOH). Such gaps in knowledge limit the ability of clinicians to intervene earlier to reduce symptoms and prevent rehospitalization. OBJECTIVE: The aim of this study was to explore HF symptoms from HFH through 6 months postdischarge and explore associations of SDOH and demographic characteristics with symptom trajectories. METHODS: We used an observational longitudinal design from HFH through 6 months postdischarge in 49 patients with New York Heart Association class III HF. Dyspnea (HF Somatic Perception Dyspnea Scale), fatigue (PROMIS-Fatigue), sleep quality (Pittsburg Sleep Quality Index), pain (PROMIS-Pain Interference), depressive symptoms (8-item Patient Health Questionnaire), anxiety (PROMIS-Anxiety), and HF-specific health-related quality of life (Kansas City Cardiomyopathy Questionnaire Short Version) measures were collected during HFH and at 1, 3, and 6 months postdischarge. Latent growth curve modeling and multivariate regression were used to characterize trajectories in symptoms and to determine associations of growth model estimates with SDOH and demographic characteristics. RESULTS: Participants (N = 49) were 68 ± 10 years, 53% women, with an average ejection fraction of 44 ± 20%. Fatigue, dyspnea, anxiety, and HF-specific health-related quality of life improved significantly from HFH through 6 months posthospitalization ( P < .05). Sleep quality, pain interference, and depressive symptoms did not change significantly from HFH through 6 months postdischarge. Novel associations between HF symptom trajectories and race, sex, education, and income were identified. CONCLUSIONS: Symptoms associated with congestion improved to 6 months after HFH while other less frequently assessed symptoms did not improve after discharge. Associations between SDOH, demographic characteristics, and HF symptoms provide new insights into social factors that may influence HF symptoms.