Women From Low-Income Households at Greater Risk for Heart Failure

Contact: Amanda Jekowsky, ajekowsk@acc.org, 202-375-6645

Heart failure (HF) – a chronic condition in which the heart can no longer pump enough blood to the body – carries serious health consequences and financial burdens for many women 65 and older. But new data show that post-menopausal women who live in low income households and have less than a high-school education are at even greater risk for developing HF, regardless of race or ethnicity and even after adjusting for known risk factors, according to a study published in the September 27, 2011, issue of the Journal of the American College of Cardiology (JACC).  
While previous studies have shown worse outcomes for patients with lower socioeconomic status who have established HF, this is the first U.S. study to demonstrate a link between lower SES and the likelihood of actually developing HF. 
According to the study, women with household incomes of less than $20,000 a year had a 56 percent increased risk of hospitalization due to HF compared to women who lived in households with an annual income above $50,000 a year. Women with less than a high-school education had a 21 percent increased risk of incident heart failure. These findings prompted authors to call for tailored prevention programs to help alleviate the disparity and burden of disease among women with lower SES.   
“In the current climate of decreasing health care resources, we must be aware of the growing population of elderly women who are at risk for heart failure,” said Rashmee Shah, MD, MS, Department of Health Research and Policy and Center for Prevention Research, Stanford University School of Medicine, Palo Alto, CA and lead author of the study. “Prevention efforts now will pay off in the future.”
Researchers say the biggest challenge facing women with low SES is an inability to access good preventive care. They report that even women who overcome financial burdens to access preventive care received lower quality care than their high SES peers. Women who are less educated also reported poor communication with their doctors.
The study used data from the Women’s Health Initiative hormone therapy trials, which surveyed 26,160 healthy post-menopausal women in the 1990s and contained self-reported income and education levels. The women’s records were checked for self-reported heart failure hospitalizations every six months over eight years. Women with lower SES were more likely to have risk factors for HF including diabetes, hypertension, and interim myocardial infraction.
Authors caution that neighborhood characteristics, access to care and health literacy may contribute to the SES disparity seen in this study; however, the association of lower income with first-time HF hospitalization risk persisted after adjusting for risk factors and other variables. Further research is needed.


The American College of Cardiology is transforming cardiovascular care and improving heart health through continuous quality improvement, patient-centered care, payment innovation and professionalism. The College is a 39,000-member nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers, and bestows credentials upon cardiovascular specialists who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at www.cardiosource.org/ACC.

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