ABSTRACT
Aims:
We aimed to investigate the influence of socioeconomic position (SEP) and
multimorbidity on cross-sectional
healthcare utilization and
prognosis in
patients after
cardiac resynchronization therapy (CRT) implantation.
Methods and
results:
We included first-
time CRT recipients with left
ventricular ejection fraction ≤35% implanted between 2000 and 2017. Data on chronic conditions, use of
healthcare services, and demographics were obtained from Danish national administrative and
health registries.
Healthcare utilization (in- and
outpatient hospitalizations, activities in
general practice) was compared by
multimorbidity categories and SEP by using a negative binomial regression model. The
association between SEP,
multimorbidity, and prognostic outcomes was analysed using Cox proportional
hazards regression. We followed 2007
patients (median age of 70 years), 79% were
male, 75% were on early
retirement or
state pension, 37% were
living alone, and 41% had low
education level for a median of 5.2 [inter-quartile range 2.2-7.3) years. In adjusted regression models, a higher number of chronic conditions were associated with increased
healthcare utilization. Both cardiovascular and non-cardiovascular
hospital contacts were increased.
Patients with low SEP had a higher number of chronic conditions, but SEP had limited influence on
healthcare utilization.
Patients living alone and those with low
educational level had a trend towards a higher
risk of all-cause
mortality [adjusted
hazard ratio (aHR) 1.17, 95%
confidence interval (CI) 1.03-1.33, and aHR 1.09, 95% CI 0.96-1.24).
Conclusion:
Multimorbidity increased the use of cross-sectional
healthcare services, whereas low SEP had
minor influence on the utilizations.
Living alone and low
educational level showed a trend towards a higher
risk of
mortality after CRT implantation.