• Eur. J. Clin. Invest. · May 2024

    Randomized Controlled Trial

    Educational status affects prognosis of patients with heart failure with reduced ejection fraction: A post-hoc analysis from the WARCEF trial.

    • Bernadette Corica, Giulio Francesco Romiti, Amalie Helme Simoni, Davide Antonio Mei, Tommaso Bucci, ThompsonJohn L PJLPMailman School of Public Health, Columbia University, New York, New York, USA., Min Qian, Shunichi Homma, Marco Proietti, LipGregory Y HGYH0000-0002-7566-1626Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.Department of Clinical Medicine, Danish Center for Health Serv, and WARCEF Investigators.
    • Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
    • Eur. J. Clin. Invest. 2024 May 1; 54 (5): e14152e14152.

    AimsThe influence of social determinants of health (SDOH) on the prognosis of Heart Failure and reduced Ejection Fraction (HFrEF) is increasingly reported. We aim to evaluate the contribution of educational status on outcomes in patients with HFrEF.MethodsWe used data from the WARCEF trial, which randomized HFrEF patients with sinus rhythm to receive Warfarin or Aspirin; educational status of patients enrolled was collected at baseline. We defined three levels of education: low, medium and high level, according to the highest qualification achieved or highest school grade attended. We analysed the impact of the educational status on the risk of the primary composite outcome of all-cause death, ischemic stroke (IS) and intracerebral haemorrhage (ICH); components of the primary outcome were also analysed as secondary outcomes.Results2295 patients were included in this analysis; of these, 992 (43.2%) had a low educational level, 947 (41.3%) had a medium education level and the remaining 356 (15.5%) showed a high educational level. Compared to patients with high educational level, those with low educational status showed a high risk of the primary composite outcome (adjusted hazard ratio [aHR]: 1.31, 95% confidence intervals [CI] 1.02-1.69); a non-statistically significant association was observed in those with medium educational level (aHR: 1.20, 95%CI: .93-1.55). Similar results were observed for all-cause death, while no statistically significant differences were observed for IS or ICH.ConclusionCompared to patients with high educational levels, those with low educational status had worse prognosis. SDOH should be considered in patients with HFrEF.Clinical Trial RegistrationNCT00041938.© 2024 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

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