Social adversity linked to worse mortality in PH

BOSTON – Social adversity is associated with worse survival in patients with pulmonary hypertension (PH), according to a new retrospective study of New York City residents. Among patients with HIV and heart failure, PH was associated with an approximately threefold increase in all-cause mortality, but that risk increased to approximately sevenfold when social adversity identified by a licensed social worker was also present.

A subanalysis of both patients with HIV and patients without HIV showed worse mortality outcomes with social adversity in both groups.

“Almost the majority of the patients we treat have social problems, are uninsured or undocumented. That is why we, as a group of residents, decided to study the impact of these factors on their health and the care that can be provided. We started using the two cohorts and now we are continuing with each new resident,” said Luca Biavati, MD, who presented the study at the American College of Chest Physicians (CHEST) 2024 Annual Meeting.

“The presence of any form of socio-economic disadvantage has a negative impact on care and for a large part of the population there are some factors that can probably be addressed by institutional or hospital policies,” says Biavati, an internist at the hospital. Jacobi Medical Center, Bronx, New York.

Other factors are more difficult to address, such as a lack of education. “(Some patients) do not understand the severity of their problem and medical condition until it is too late, and then they are not fit enough for the treatment, or they cannot be eligible for advanced therapies due to the social situation,” Biavati said .

The researchers put together two cohorts: one consisting of patients with HIV and heart failure who may or may not have had PH, and one consisting of patients with PH with or without HIV and heart failure. In the HIV/heart failure group, PH without social adversity was associated with a nearly threefold increase in all-cause mortality (hazard ratio (HR), 2.83; P = .004), while PH with social adversity was associated with a more than sevenfold increase in all-cause mortality (HR, 7.14; P P

Within the PH cohort, social adversity was associated with lower survival (P P = .040), transportation problems within the HIV population (HR, 12.8; P PP = 0.028).

The research led to interventions, which Biavati said are now being studied at the institution. “We have a policy of giving medicine in bags when we discharge a patient with social setbacks. We literally go to the pharmacy, bring up the bag of medicine and put it in their hands before they leave the hospital. They are given a 1 or 3 month supply depending on the medication, and then we usually discharge them with a clinical appointment already scheduled with a pulmonary or primary care provider, and we usually call them before each appointment to confirm that they are ready are. coming. That increases the chance of some success, but there is still a long way to go,” Biavati said.

Biavati was blind to the results of the intervention, so he couldn’t report whether it worked. “But I can tell you I’ve had busier clinics, so hopefully that means they’re showing up more often,” he said.

The problem is complex, said Sandeep Jain, MD, who moderated the session. “Social hardship means a lack of education. Lack of training means lack of compliance. Lack of compliance means: what can you do if people don’t take medicine? So it’s all coordinated. It’s all a lack of education, a lack of money, a lack of family support. And they have to take these medications every day. It’s not that simple. It is very easy for us to say that I have been on antiretroviral treatment for six months. It is almost impossible to continue regular treatment for so long (for a patient with social setbacks). You can’t blame them if they don’t undergo treatments. It is very difficult for them,” Jain said.

This underlines the need for interventions that can meet the needs of patients with social adversity. “When practicing medicine, we must take into account the social situation of the patient and not just the medicine we study in books. That’s what we face every day. We have therapies, and then life happens. It is much more difficult to care for these patients,” says Biavati.

Biavati and Jain reported no relevant financial relationships.

Jim Kling is a writer in Bellingham, Washington.