Impact of socioeconomic factors on hospital readmission in patients 65 and over hospitalized for Heart Failure or Acute Myocardial Infarction: a Systematic Review of the literature

Background Cardiovascular diseases (CVD) are the leading cause of death and disability in the world. Heart failure (HF) and acute myocardial infarction (AMI) are two of the most common causes of readmission. In 2011, 6.5% of patients in UK and 14.2% of patients over 75 in France were readmitted within 30 days after discharge. The readmission rate for AMI was 19.9% and for HF was 24.4%. Several socioeconomic (SE) factors could affect readmissions. Therefore, a systematic review was conducted to identify the impact of SE factors on the risk of readmission in people over 65 with HF or AMI. Methods A systematic review of the literature was carried out, according to PRISMA Statement, by querying Medline database and hand searching. Studies with an association between the risk of readmission and at least one SE factor, in patients 65 and older with HF or AMI, were included in the review. A quality assessment was conducted independently by two reviewers, using STROBE Statement. The agreement between reviewers was quantified by Cohen’s Kappa test. Data were categorized according to the SE variables and the considered outcome. When the exposure to a deprived SE condition increased the risk of readmission, a positive effect was considered. Finally the evidence were graduated according to the quality score. Results Out of 2016 studies, 11 were included in the review, for a total population of 4.369.758. All the studies analyzed patients with HF and 4 of them analyzed patients with AMI, also. At 30 days, a positive effect was found with being hispanic and black (3 studies) and in a low level of income (1 study), both for HF and AMI. At 90 days, only being unmarried showed a positive effect (2 studies). At 6 months, lower level of social network was found as a disadvantage factor (1 study). Finally, at 1 year, black patients (1 study) and people with low level of SE status (1 study) showed a positive effect. Conclusion Race/ethnicity and marital status can affect the risk of readmission in elderly people with HF or AMI. Transitional care and other programmes, aimed at guaranteeing continuity of care, are a priority for healthcare systems, not only to achieve better integration of care, but also to reduce disparities in readmission for this target population. Key message This review contributes to the debate about disparities in healthcare by the identification of some socio-economic condition which should be taken into account to prevent readmission in the elderly.