Elderly African Americans with heart failure are more likely to be hospitalized for heart failure compared to their white counterparts. However, African Americans with heart failure also frequently have similar or even lower 1- year mortality compared to white heart failure patients. Previous studies have shown that factors such as post-discharge care, the unique role of heart failure among African Americans, comorbidities, and access to care may account for the some of disparities in hospital use. However, fewer studies have examined non-clinical factors such as patient social support. Social support is essential to the successful outpatient management of heart failure, particularly among the elderly. Social support, provided by family or friends, may facilitate the adoption of and adherence to self-management behaviors such as checking daily weights and maintaining a low sodium diet. Social support may decrease heart failure morbidity through this mediating role in the relationship between self-management behaviors and hospital use for heart failure. The proposed research will include a prospective cohort study of African American and white adults over age 40 previously hospitalized for heart failure 1) to assess the relationship between social support and heart failure 2) to assess the relationship between self-management behaviors and hospital use for heart failure 3) to measure the extent to which social support mediates the relationship between self-management behavior and hospital use for heart failure. Study participants will be selected using administrative data on hospital discharges from a single large teaching hospital. At study entry, a survey instrument will be administered with validated scales to measure social support and self-management behaviors. In addition, other data on trust in physicians, comorbidities, functional status, medication use and adherence will be collected via the survey. At the end of the 1-year follow-up period, administrative hospital data will be used to measure hospital use for heart failure at the same teaching hospital for all study participants during the previous 12 months. In the data analysis, multivariable modeling will be used to examine the independent relationships of both social support and self- management behaviors with hospital use for heart failure in this diverse cohort. Furthermore, sequential model building will be utilized to determine if social support is a mediator in the relationship between self-management behaviors and hospital use for heart failure. The proposed research will help to elucidate the relationships among these patient factors and hospital use for heart failure. Additionally, the research should inform future work in the design of community-based interventions to augment or optimize social support in efforts to address racial disparities in hospital use for heart failure.
Heart failure affects about 2.6% of adults in the US and is the leading cause of hospitalizations annually among Medicare beneficiaries. Racial disparities in hospital use for heart failure reflect a higher burden of disease among elderly African Americans with heart failure compared to whites. The elucidation of the role of social support as it relates to self-management behaviors and hospital use for heart failure is essential to the creation and implementation of community-based interventions to address these health care disparities.
